Treatment helpful up to 4 1/2 hours after stroke

In the third European Cooperative Acute Stroke Study, which was sponsored by German pharmaceutical giant Boehringer Ingelheim, it was found that tPA (tissue plasminogen activator) treatment may still be moderately beneficial when given three to four and a half hours after an acute ischemic stroke. When compared with the patients that were given the tPA drug within a three hour window, trial patients that received the drug up to four and half hours after an ischemic stroke were equally as likely to suffer symptomatic intracerebral hemorrhages and had no increased risk of death. However, authors of the study, which was published in the New England Journal of Medicine, still stress the importance of treating a stroke as soon as symptoms arise.

At this point in time, tPA is the only drug approved for treating ischemic strokes, though its use for treatment is currently only allowed within the three hour window. This new study, however, may expand that window to include up to four and a half hours, though more extensive research is still needed before approval. In another study published in The Lancet, conclusions from the Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Registry provided additional evidence that there is no substantial difference between treating ischemic stroke before the three hour limit and treating within the three to four and a half hours window. If the approved window of time was increased from three hours to four and a half hours, doctors would be able to help a larger percentage of patients who have suffered a stroke.

The European Cooperative Acute Stroke Study 3 was a causal trial which used both the intravenous tPA drug and a placebo, a substance with no pharmacological effect. Researchers utilized 821 stroke patients that arrived for treatment three to four and half hours after stroke symptoms were first experienced. Ten percent of those patients were treated between three and three and a half hours, 50 percent between 3 and a half and four hours, and 40 percent between four and four and a half hours. The study concluded that a greater number of patients had a positive outcome after ninety days when treated with the tPA drug rather than the placebo. Further research is still required before doctors will be permitted to treat ischemic stroke patients with tPA beyond the three hour window, though the most recent study results point in that direction.

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