Receiving a clot-buster drug before reaching the hospital may reduce stroke disability

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Stroke patients receiving clot-busting medications before arriving at the hospital have a lower risk for disability afterward, according to research presented at the American Stroke Association’s International Stroke Conference 2017 (ISC; 22–24 February, Houston, USA).

Researchers analysed results from 658 stroke patients who were treated with tissue plasminogen activator (tPA). About half of the participants received the clot-busting drug at the hospital, and half received it while still in the ambulance.

This preliminary study showed that three months after stroke, 182 out of every 1,000 patients treated before arriving at hospital were less disabled, including 58 patients who had zero disability, compared to people who received treatment after reaching the hospital.

“Time is brain in acute stroke after vascular collaterals fail, and faster treatment yields better outcomes,” says May Nour, lead researcher, interventional neurologist and director of UCLA’s Mobile Stroke Rescue Program, Los Angeles, USA. “Our study shows pre-hospital clot-busting is a promising, evolving approach to providing tPA stroke therapy. Its better outcomes could offset the increased costs of a mobile stroke unit.”

Past research showed the sooner that a clot-busting tPA drug is given after an ischaemic stroke the better patients fare. But tPA is not indicated and could hurt a patient’s chances if they are having a haemorrhagic stroke, in which a blood vessel ruptures. That is why patients need a computed tomography scan to confirm the type of stroke before receiving tPA.

Nour’s team used data from Berlin’s PHANTOM-S study, which took place from 2011 to 2015 and included 427 participants (median age 72) which were compared to 505 patients who received conventional care with in-hospital clot-busting. Researchers analysed information about patients’ disabilities to determine how many needed to be treated in the mobile stroke unit to yield a greater benefit in disability outcomes when compared to patients who received tPA at the hospital.

The findings bordered on statistical significance, suggesting that future clinical trials with a greater number of patients are needed to show similar benefits.

“People should know the warning signs of stroke and call [their local emergency number] as soon as they observe stroke signs,” says Nour. “Treatment then needs to happen as quickly as possible, and a mobile stroke unit may allow that to happen.”