Stroke Guidelines Focus on Critical First Hours

Intravenous delivery of the clot-busting drug tPA is still the best treatment for patients in the crucial first few hours after an ischemic stroke, say new guidelines released by the American Heart Association/American Stroke Association.

Ischemic strokes, the most common kind of stroke, are caused by a clot that blocks blood flow in an artery in the brain.

"We are pushing for the fastest possible treatment, because 'time is brain.' For every minute that goes by, the likelihood of a poorer outcome increases," Dr. Harold P. Adams Jr., chairman of the guidelines' writing group, said in a prepared statement.

He and his colleagues noted that intravenous delivery of the clot-busting drug tPA (tissue plasminogen activator) is only approved to be used within three hours of the onset of ischemic stroke symptoms.

Other techniques, such as mechanical devices to remove blood clots and intra-arterial administration of tPA, show promise and should be considered for patients with moderate-to-severe ischemic stroke who arrive too late at the hospital to receive intravenous tPA treatment, the writing group said. They also noted that information on these techniques is limited, and more research is needed.

The guidelines also recommend that emergency medical personnel do a quick stroke assessment, draw blood and alert the hospital about the impending arrival of a patient with a suspected stroke. Stroke patients should be transported to the nearest "appropriate" hospital for emergency stroke care, even if this means bypassing the nearest medical center or calling for air evacuation.

Among the new or revised recommendations in the guidelines:

• Hospitals should develop emergency stroke protocols so that patients can be assessed and treated within 60 minutes of arrival.
• More medical centers should seek certification as primary or comprehensive stroke centers.
• Patients should receive early and carefully chosen treatments for abnormal blood pressure, fever or abnormal blood sugar levels, which can have a negative effect on a stroke patient's outcome.