The Benefits and Limitations of TPA Stroke Treatment - Oren Zarif - TPA Stroke

Fortunately, the latest data from tPA stroke trials are starting to be incorporated into clinical practice. While the FDA has not approved tPA stroke treatment after three hours, doctors have the option to offer it off-label. For every minute that a patient waits after receiving tPA, their chances of improving dramatically diminish. This new research suggests that physicians should offer tPA treatment during head CT scans. Listed below are a few of the most significant benefits and limitations of tPA stroke treatment.

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To assess the effectiveness of tPA stroke treatment, doctors must first understand the severity of a patient's stroke. The National Institutes of Health Stroke Scale (NINDS) is used to assess the severity of stroke. Using this information, researchers have calculated the chances that tPA treatment would benefit patients, and whether it would harm them. Based on this study, it was estimated that tPA stroke treatment would improve the lives of 16.9 patients, while only 3.4 patients would have suffered a serious complication. The authors note that although the treatment is not as effective as earlier studies, it still offers significant benefits for patients.

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A recent study supported by grants from the National Institutes of Health found that tPA improves stroke outcomes without reducing mortality. Researchers from the University Hospitals of Leuven in Belgium and Boehringer Ingelheim Pharma GmbH & Co. in Germany reported that their study showed the best outcomes without any negative impact on mortality. This study may ultimately change the way doctors approach stroke and the care of patients. And it may even decrease the need for invasive procedures.

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Nonetheless, despite its numerous benefits, tPA is still unsuited for all stroke patients. In a study, patients were treated with tPA within three hours of the onset of their symptoms, and 27% were treated with TPA therapy. The other 31% were excluded because the symptoms were too mild or quickly improving. Although tPA is a great option for many stroke patients, it should be used cautiously.

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The risk of bleeding from tPA therapy is high. Patients with high blood pressure or subarachnoid hemorrhage are at higher risk of bleeding. Therefore, it should be administered only after a stroke-prone patient has undergone a full diagnostic evaluation. Moreover, patients with high risk of bleeding are not recommended for tPA therapy. But those who do not meet the criteria for this therapy should also be monitored closely.

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In 1987, tPA was approved for treatment of heart attacks. More research is needed to elucidate the molecular mechanisms that make tPA effective. For now, the FDA-approved tPA stroke treatment is the only approved therapy for heart attack. But it has its drawbacks as well. The adverse effects associated with the drug may prevent its use. The risk of bleeding is also greater in patients with chronic renal disease.

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Aside from direct thrombolysis, the use of neuroprotectants has also been studied for treatment of stroke. Neuroprotectants can inhibit the activation of the nuclear factor k-B-cell receptor (NF-kB) and activate the Akt protein, which is believed to be pro-survival. In the present study, PDTC was given intravenously or by gastric gavage to rats with acute stroke. Right frontal cortex and the cerebral cortex were harvested to assess neurological outcomes.

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One study has concluded that tissue plasminogen activator is the only approved treatment for acute ischemic stroke. It is also associated with increased mortality, hemorrhage, and reperfusion injury. In addition, delayed administration of tPA has been linked to increased intracranial hemorrhage and reperfusion injury. In addition, the drug stimulates matrix metalloproteases, which further disrupt the BBB.

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In addition to its effectiveness, IV tPA is resource-intensive, and the availability of teaching hospitals may have a significant impact on a patient's ability to receive it. Although thrombolysis is a potentially beneficial treatment for patients suffering from acute ischemic stroke, some research has found that up to 25% of patients with this type of acute ischemic stroke were not treated within three hours. The American Stroke Association strongly recommends that patients receive tPA as soon as possible after their symptoms appear.

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Recent clinical trials suggest that tPA plus argatroban may have a beneficial effect in patients undergoing endovascular therapy. Results from the ECASS III phase III trial, which tested tPA after three to 4.5 hours of ischemia, indicate that the combination improves outcomes. Although a low-dose tPA plus rA2 combination may be more effective than tPA alone, this is not yet a clinically useful tool.