When a person suffers an ischemic stroke, there is only one medication approved to help break up the clot that causes the stroke. That medication is tissue plasminogen activator, or tPA, and SSM Health Neurosciences stroke teams are administering it at a rate twice the national average.
What does that mean for our stroke patients? They have a much greater chance of limiting the disabling effects of stroke and experiencing a faster, more significant recovery.
“SSM Health hospitals are doing a great job of administering tPA to our acute ischemic stroke population,” said Sharon Pulver, SSM’s Network Stroke Coordinator. “Across the nation, an average of only five percent of stroke patients receive tPA, whereas our five hospitals are averaging 10 percent.”
tPA has been available since 1996 and is the only FDA-approved drug to treat acute ischemic strokes, the most common form of stroke. It can be used up to 4.5 hours after the onset of stroke symptoms; after that time, it is less effective because the damage to the brain becomes permanent.
So why isn’t tPA used even more frequently? “Many times physicians look for a reason not to give tPA,” Pulver adds. “There are bleeding risks associated with tPA, so it does require careful screening of patients to ensure it can be administered safely and effectively. Plus, if the patient doesn’t arrive within 4.5 hours, we cannot give the drug.”
tPA is administered intravenously in the emergency department after a CT exam has shown that the stroke symptoms are not being caused by a hemorrhagic (bleeding) stroke. Because it prevents clotting, tPA could worsen a bleeding stroke.
“We have made great efforts to educate our ED physicians and staff about appropriate use of tPA,” Pulver said. “We have established stroke response teams that include neurologists who help guide us in the safest, most appropriate use of tPA. The neurologist on call assists the ED physician in making the decision to administer tPA.”
In 2009, a multidisciplinary team of neurologists, neurosurgeons, radiologists, emergency physicians and nurses developed and implemented standardized, evidence-based stroke protocols across SSM’s adult hospitals. The protocols are activated as soon as a stroke patient arrives in the emergency department. In addition, SSM hospitals adhere to these American Stroke Association guidelines:
- Stroke patient is seen in the ED within 10 minutes of arrival
- A CT imaging exam is completed within 25 minutes of arrival
- Lab and CT results are provided within 45 minutes of arrival
- tPA is administered to eligible patients within one hour of arrival
Because successful stroke treatment is time-dependent, Pulver and her team of stroke coordinators have worked hard to educate the community, EMS personnel and all SSM employees about stroke signs and symptoms.
“There tends to be no pain with a stroke,” Pulver adds. “Many people sit at home thinking their symptoms will improve if they ride it out. If they recognize the symptoms and act quickly there is a much greater chance we can help them with tPA or a clot retrieval intervention.”
Education about stroke treatment appears to be making progress. Stroke recently dropped from the third leading cause of death to the fourth, despite an aging population that faces increased risk for stroke.