Ischemic strokes, where blood supply to the brain is blocked by blood clots or plaque, account for 85% of all strokes (CDC, 2010). Early treatment with the use of tissue plasminogen activator, or tPA, is the main drug of choice to help breakdown clots and reduce the likelihood of mortality. Previously, the guideline stated that tPA must be administered within three hours of symptom onset. However, the American Stroke Association's (ASA) new guidelines have expanded this narrow window to four and a half hours.
The Food and Drug Administration (FDA) has formerly declined the four and a half hour time frame, but recent findings from the European Cooperative Acute Stroke Study have prompted the FDA to consider the extension. Extending the time frame is believed to decrease the risk of obtaining long-term post-stroke disabilities and help stroke victims achieve a better outcome (Hacke et al., 2008). The key to administering tPA in a timely manner, however, lies in the early and accurate diagnosis of physicians. Determining whether the stroke is ischemic or hemorrhagic in nature is crucial because incorrectly administering tPA to a person suffering from a hemorrhagic stroke is detrimental. For this reason, the new guidelines also recommend the utilization of telemedicine. Telemedicine provides real-time audio and video access to stroke expertise, where early vigilant treatment decisions can be implemented for the patient.
Other new recommendations include the introduction of stent retrievers to remove blood clots more efficiently than tPA and using multidisciplinary quality improvement committees to monitor and improve stroke care in hospital facilities.
Time is of the essence when it comes to the management of ischemic stroke. When it comes to spotting a stroke fast, the ASA encourages people to think F.A.S.T.
Facial drooping: Does one side of the face droop or feel numb?
Arm weakness: Is one arm weak or numb? Does one arm drift downward when asked to raise both arms?
Speech difficulty: Notice any slurred speech? Is the person having difficulty speaking or understanding speech? Can they repeat a simple sentence correctly?
Time to call 911: Call for help if the person manifests any symptoms.
Think F.A.S.T. and act fast!
References
Centers for Disease Control and Prevention (CDC). (2010). Types of Stroke. Retrieved from http://www.cdc.gov/stroke/types_of_stroke.htm
Hacke et al. (2008). Thrombolysis with Alteplase 3 to 4.5 hours after acute ischemic stroke. The New England Journal of Medicine, 359. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa0804656
Jauch et al. (2013). Guidelines for the early management of patients with acute ischemic stroke. Retrieved from http://stroke.ahajournals.org/content/early/2013/01/31/STR.0b013e3182840...
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