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  • Writer's pictureOren Zarif

TPA As a Treatment for Stroke - Oren Zarif - TPA Stroke

TPA (tyrosine phosphate) is an effective treatment for ischemic strokes. It restores blood flow to the areas of the brain affected by the stroke, minimizing damage and functional impairment. However, the results of the trial are not yet conclusive. Doctors and researchers are evaluating tPA to determine the best course of action for individual patients. For now, doctors and researchers are evaluating the best options available to improve the odds of stroke recovery.

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In the early 1980s, the first studies on tPA were conducted in animal models. They also included a small number of patients with heart attack but not strokes. Fortunately, biotechnology helped change this by allowing scientists to clone genes and express proteins in cell cultures. Genentech was able to produce recombinant tPA in sufficient quantities for clinical trials. In 1984, the National Heart, Lung, and Blood Institute sponsored a multicenter clinical trial of tPA.

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In a retrospective review of more than 3,400 stroke patients in the US, the effectiveness of tPA was assessed for up to a year. The researchers observed a significant increase in the proportion of patients with no disability following tPA treatment. These results correspond to the 'number needed to treat' of 8.3, which means that tPA treatment would improve the health outcomes of at least one patient. This study supports this assertion because tPA administration can reduce OTT time.

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However, this treatment has several drawbacks, including a small number of patients with milder strokes, a lack of neurological expertise, and a perception that it may not work in certain high-risk subgroups. This lack of knowledge has hindered tPA's effective use. To overcome these challenges, more research is needed. The next steps are improved tPA diagnostics, improved neuroimaging, advanced neuromarkers, and improved alternative reperfusion methods.

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The development of rapid treatment protocols revolutionized acute stroke care in the U.S. Many hospitals created organized stroke teams and resources to become primary tPA stroke centers. The approval of tPA also led to the launch of a public awareness campaign by the NINDS. Through media and Spanish-speaking communities, the Know Stroke campaign reached millions of Americans. The campaign helped increase awareness of stroke and how to detect it in time.

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In addition to tPA, the use of argatroban may also help prevent clots from forming. This treatment may reduce the risk of brain bleeding and extend the time window for stroke recovery. While tPA is still an effective treatment for acute stroke, new developments are being developed to improve its efficiency. For instance, tPA-based devices called clot-retrieval devices have shown improved outcomes over tPA alone in clinical trials. The FDA approved these devices in 2015.

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Neuroprotective agents have been shown to improve outcomes in animal models of ischemic stroke. These agents are known for their antioxidant and neuroprotective effects. Studies have shown that tPA-containing drugs improved limb paresthesia in rats after intravenous administration. In an experimental rat stroke model, mice received IV tPA-EGCG (20 mg/kg) at 4 hours. It significantly reduced infart volume and edema. It also induced upregulation of PAI-1 and decreased MMP-2 expression, which all correlated to improved stroke recovery.

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Although tPA-based treatment has proven to be effective, access to the drug remains a significant barrier for many patients. Many patients with acute ischemic stroke are unable to receive treatment until several hours have passed. This is why the American Stroke Association strongly recommends the use of this treatment for patients with acute ischemic stroke. However, sustaining high rates of IV tPA administration has been a difficult problem. Insufficient resources, insufficient knowledge, and a variety of factors have impeded its use in clinical practice.

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Although tPA is the only treatment for acute ischemic stroke, it is associated with increased mortality, reperfusion injury, and intracranial hemorrhage. It also has potential to exacerbate the disease by activating matrix metalloproteases, which disrupt the BBB further. Hence, there is a need for multi-component quality improvement approaches to increase the rate of tPA in acute stroke care.

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There are two types of tPA therapy: intravenous and endovascular. The former is used to dissolve clots and restore perfusion. tPA is also used in endovascular surgery. Endovascular surgery is a technique that involves removing clots from inside a blood vessel. The procedure requires no invasive surgery and requires only a few hours. The other option is to use tPA after a stenosis.

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