Treating mild strokes with a clot-busting drug usually reserved for more severe strokes could prevent disability and reduce costs, according to a study released at the International Stroke Conference this week.
Researchers at the University of Cincinnati say the move could save $200 million annually on disability costs, and leave fewer people with the disabling after-effects of a stroke.
Doctors currently use the drug, an intravenous tissue plasminogen activator (tPA), to treat people with strokes caused by blood clots, known as ischemic strokes. It has been proven to reduce disability rates in patients with acute strokes, but has not yet been tested on those with mild stroke, as researchers believed such strokes did not often cause lasting damage, and the drug carries some risk of brain bleeding.
"Leading stroke centers vary on how they treat mild strokes. Doctors often assume that people with mild deficits will get better with time, but it's hard to know. They do have more disability than the term 'mild' suggests," said lead the researcher on the study, Pooja Khatri, MD, an associate professor in the department of neurology at the University of Cincinnati Academic Health Center.
Various studies over the past five years, however, have shown that about a third of those who suffer mild strokes are disabled three months after it occurs. There is currently no clinical definition of "mild" stroke, Khatri points out.
"It can be tough right now to make the decision whether to treat a patient with tPA or not. We hope that more research into how these patients respond to tPA will help doctors make these decisions in the future."
The study examined the hospital records of all patients who had been hospitalized or had deceased as a result of a transient ischemic attack (TIA) in a five-county region in greater Cincinnati and Northern Kentucky. Researchers looked at the records of people who arrived at the hospital within 3.5 hours of the onset of stroke symptoms. In order to benefit, stroke patients must receive the drug, within 4.5 hours of the onset of symptoms.
Of those patients whose strokes were considered mild, very few received tPA, regardless of the fact that they had arrived in time, and mild stroke does often lead to disability.
Researchers mapped these results to the United State population and determined that if tPA does, in fact, end up being an effective treatment for mild stroke, approximately 2,000 fewer people would end up being disabled as a result of the stroke.
Conservative estimates of lifetime disability costs are about $100,000 per patient. Therefore, researchers theorize that at least $200 million can be saved each year in disability costs as a result of disability caused by mild stroke.
Approximately 795,000 people have a new or repeat stroke every year. Of those, about 610,000 are first time events and 185,000 are recurrent. Khatri said that about 43,000 people who seek medical help for a stroke are having what would be considered a "mild" stroke and arrive in time to benefit from tPA.
Dr. Gregory Lekovic, MD, PhD, a neurological surgeon at St. Vincent Medical Center in Los Angeles, added that assessing stroke patients is challenging since things can progress and change quickly. "What may look like a mild stroke at two o'clock can be a coma at three o'clock," Dr. Lekovic said. He added that a bigger issue in treating stroke patients is triaging them so that the EMS system will take patients having strokes directly to stroke centers.
See Also:
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