Most stroke patients arrive at the hospital too late to take advantage of a clot-busting drug that significantly reduces stroke symptoms and lessens the chance of permanent disability, according to researchers at the Yale School of Public Health.
The Yale team found that U.S. hospitals are increasingly using tissue-type plasminogen activator ( t-PA ) for ischemic stroke patients. However, the proportion of those patients arriving in time to benefit from the drug, which needs to be delivered within three hours of the onset of symptoms, has changed little over a three-year period.
Lead researcher Judith H. Lichtman, Ph.D., associate professor in the division of Chronic Disease Epidemiology, says the findings suggest that more needs to be done to educate people about stroke symptoms and the importance of receiving prompt medical care. "Almost two-thirds of patients are not even making it to the hospital in time to be eligible for t-PA," Lichtman says, adding, "One of the greatest challenges for acute stroke care is getting patients to the hospital as soon as they experience stroke symptoms, so that therapy is given within the treatment window."
The study reviewed the medical records of 428 patients from 2001 and 481 patients from 2004 who were treated at one of more than 30 academic medical centers in the United States. In both years only about 37 percent of all stroke patients arrived at the hospital in time and black patients were 44 percent less likely than white patients to arrive at the hospital within two hours of symptoms.
t-PA is the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke. The study also found that hospital use of t-PA is increasing, with 37.5 percent of eligible patients receiving the drug in 2004, up from 14 percent in 2001.
Stroke warning signs include sudden numbness or weakness in the face, arm or leg, especially on one side of the body; confusion, trouble speaking or understanding;
difficulty seeing in one or both eyes; and problems walking, dizziness, loss of balance or coordination.
Lichtman says, "This study shows us that making a change in the receipt of acute care is a complex problem. We need to get better at educating the public about how to recognize the signs and symptoms of stroke. This means not only improving awareness, but also changing behaviors so people who are suspicious that they are having a stroke seek immediate medical care."
Co-authors are Emi Wantable and Sara Jones from Yale, Norrina Allen from Northwestern University, Jackie Dostal from University HealthSystem Consortium, and Larry Goldstein from Duke University.
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