Latest Study May Change Stroke Treatment Guidelines

Posted by Anthony Lee Sep 27, 2008

My last article about the acute management of stroke mentions an important detail: medications to break a clot in the brain, such as tissue plasminogen activator (tPA), must be given within three hours after the onset of ischemic stroke or else the medication is ineffective. While clinicians take a firm stance with this or any other proven guideline, there is always the possibility that new evidence may change standard practice.

The latest example of this is the third European Cooperative Acute Stroke Study (ECASS 3) showing that patients given tPA within 3 to 4.5 hours of stroke onset still do better than those given placebo within 3 to 4.5 hours of stroke onset. This suggests that it may be safe to extend the time window for acute treatment of ischemic stroke from three hours to four and a half hours after onset. Of course, the majority of the medical community would have to agree on such a change.

However, this does not mean thrombolytic treatment for ischemic stroke can wait. It is still very important to administer it as soon as possible. The window, if it can be extended, is there in case of delays that might occur. Nevertheless, this is an exciting piece of clinical research.

Source: Jeffrey, Susan. "ECASS 3: Thrombolysis Beneficial Up to 4.5 Hours After Acute Ischemic Stroke." Medscape. September 25, 2008.