Improving Ischemic Stroke Outcomes With TPA - Oren Zarif - TPA Stroke
There are several studies showing that the administration of tPA to a patient with a ischemic stroke significantly improves health outcomes. But the current protocol has a 26-minute delay in administering the medication. A recent study suggests that the timing of tPA administration during head CT scans can reduce OTT. A radiology suite-based tPA administration could improve health outcomes for stroke patients. However, the research needs to be further confirmed.
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tPA was used to treat ischemic stroke patients in the Highland Hospital, following national guidelines. In fact, 100% of acute stroke patients were treated with tPA. The disease occurs when blood flow to the brain is impaired. Blood clots or plaque can block vital blood vessels in the brain. Sometimes, a blood vessel in the brain bursts, spilling blood into the surrounding tissue. In this case, the patient may experience hemorrhagic stroke.
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Despite the potential risks, the Lansberg study supports the use of tPA in ischemic stroke. Researchers analyzed the data from six previous trials to determine the risk of harm and benefit with the new drug. The researchers estimated that 16.9 patients would benefit from tPA treatment, while only 3.4 would experience adverse effects. Although the tPA treatment is not as effective as other options, it provides a significant benefit for patients.
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In addition to a recent study, tPA infusions have improved outcomes for patients with ischemic stroke. In a randomized trial of 2,044 patients, tPA increased the number of patients with minimal or no disability. Consequently, tPA-treated patients require more treatment than a placebo. This is reflected in the fact that the majority of patients who do not reach the hospital early enough to receive the drug are still suffering.
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A multiphase DTN time quality improvement approach has been developed to optimize tPA administration. The team implemented a STAT stroke protocol, which pre-notifies the stroke team of incoming patients. Then, the team transports patients to the CT scanner on EMS stretchers. Moreover, tPA administration can begin immediately at the CT scanner, reducing the time between onset of stroke and the administration of the drug.
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The AHA/ASA 2013 update has published a clinical evidence-based guideline for tPA administration to AIS patients. The guideline details the clinical effectiveness of tPA in patients with ischemic stroke. A prospective endovascular database was collected at a comprehensive stroke center between 2012 and 2019. The outcomes of the treatment were compared with those treated with EVT alone. The results show that tPA infusion can improve outcomes by up to 30%.
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Acute ischemic stroke is the leading cause of death and morbidity worldwide. It is critical to maximize the chances of recovery through treatment with thrombolysis. This medication converts inactive plasminogen into an active form known as plasmin, which promotes thrombolysis. In addition, multiple studies have found a positive correlation between the time taken to administer tPA and the improved outcomes for patients. The longer the delay in tPA administration, the worse the outcome.
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A large multicenter clinical trial, called the NINDS Stroke Study Group, found that tPA had a 30% relative risk reduction compared with placebo. While tPA is the only approved drug for acute ischemic stroke, it is still significantly underutilized. In fact, it is currently approved in the US for all patients who meet certain criteria. This means that the potential for a substantial improvement in access to thrombolysis is still high.
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In a recent study, the National Institutes of Health funded the administration of IV tPA in a randomized trial. The trial showed that tPA significantly improved 90-day outcomes without increasing mortality. While tPA has many advantages, its effectiveness and safety remains a matter of debate. However, one study demonstrates the value of tPA for patients with AIS. There is currently no clear winner in tPA stroke treatments, so there is no definite cure for stroke yet.
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In a separate study, tPA and neuroprotective agents inhibit ischemia-induced neurodegeneration. They also inhibit the activation of the nuclear factor (NF)-kB. In addition, they activate Akt, a protein known to be a pro-survival protein. This treatment also reduces the incidence of HT and ICH, which is another important outcome of tPA stroke. The results of this study are important for determining which stroke treatment is most effective.
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PDTC significantly reduced the frequency of tPA-induced hemorrhage in a rat model of ischemic stroke. In addition, PDTC reduced the expression of proinflammatory cytokines, oxidative stress, and MMP-9 activity in the right frontal hemisphere. These findings are promising and point to a more effective treatment for ischemic stroke. So, while tPA is effective, it has risks and is not yet the best choice for stroke patients.