THURSDAY, June 3 (HealthDay News) -- Researchers report that
only about a quarter of people who have strokes caused by blocked
arteries arrive at a hospital within one hour of the attack -- the
"golden hour" where treatment with a powerful clot-dissolving drug
is expected to work best.
The report also notes that only one in four of patients who
do arrive within an hour go on to get the potentially
lifesaving therapy, called tissue plasminogen activator (tPA).
Overall, there is a "modestly improving trend" in time of
arrival at hospitals of patients with ischemic stroke, the most
common form, said study author Dr. Jeffrey L. Saver, director of
the Stroke Center at the University of California, Los Angeles.
His team's report uses data from nearly 107,000 stroke patients
treated between 2003 and 2007 at 905 hospitals participating in the
American Stroke Association's "Get With the GuidelinesStroke"
Ischemic stroke, where a clot blocks an artery, can be treated
by injecting tPA, which can quickly dissolve the blockage.
Restoring blood flow quickly is key to limiting stroke damage.
Current guidelines direct that tPA be given for up to 4.5 hours
after a stroke occurs, but it is best used during the first three
Time of arrival is a key to getting that treatment within that
window, the study shows. While one in four patients arriving in the
"golden hour" got tPA, only one in eight arriving one to three
hours after stroke onset got the drug, and virtually none arriving
later than that got the treatment.
Why do so many patients not receive tPA, even if they arrive at
the hospital relatively soon? According to Saver, there are a
number of necessary steps that have to be gone through before the
treatment can be given. "A stroke physician must examine the
patient to determine that a stroke has occurred, a brain scan must
be done to determine whether it is an ischemic stroke, blood tests
must be done to be sure than tPA therapy will be safe, a medical
history must be done and informed consent obtained," he said.
Several measures are being taken to speed that evaluation
process, Saver said. One is to have paramedics in the ambulance
call ahead to alert the hospital about the probable need for stroke
Another effort is aimed at raising public awareness of stroke
symptoms and what should be done when they occur, said Dr. Ralph S.
Sacco, chairman of neurology at the University of Miami Miller
School of Medicine, and president-elect of the American Heart
The association's public education program stresses the
recognition of stroke symptoms, such as a sudden loss of vision,
sudden speech problems, sudden severe dizziness and sudden severe
"We currently tell the public to call 911 when these happen, because 'time is brain' and every delay in getting to the closest stroke center reduces the chance of improvement," Sacco said.
Callers should wait for the paramedics to arrive rather than
heading to the hospital themselves, Sacco said. "Studies have shown
that those who are brought to the hospital by the family do not get
triaged as rapidly for stroke as those who arrive by ambulance," he
Triage is the determination of the problem that brought the
patient to the hospital, and prioritizing the patient in relation
to others waiting for care.
A truly critical moment -- recognizing that this
is a stroke -- occurs in the moments before a 911 call is
made, Sacco said.
"Lack of awareness of the warning signs of stroke is the single greatest reason why people do not get treatment in time," he said.
Find out more about the warning signs of a stroke at the
American Heart Association.