People having an ischemic stroke -- which accounts for nine in 10 strokes -- should receive clot-dissolving therapy, if appropriate, within 60 minutes of arriving at the hospital, according to new American Stroke Association guidelines published in the American Heart Association journal Stroke.
Ischemic stroke is caused by a blood clot in the arteries leading to the brain. Calling 9-1-1 immediately after recognizing any of the warning signs of stroke -- and getting to a stroke center as fast as possible -- are still the most important steps for optimal stroke care.
Rapid action a must
During an acute stroke, physicians must evaluate and diagnose the patient as soon as possible to determine if the patient is eligible to receive the clot-dissolving drug recombinant tissue plasminogen activator (tPA), which must be given 4.5 hours within hours of symptom onset. The goal is to minimize "door to needle" time which provides the patient with the best opportunity for benefit from the treatment.
"tPA can now be considered for a larger group of patients, including some those who present up to 4.5 hours from stroke onset," said Edward Jauch, M.D., lead author of the guidelines and director of the Division of Emergency Medicine at the Medical University of South Carolina.
The new guidelines recommend integrating regional networks of comprehensive stroke centers (which offer 24/7, highly specialized treatment for all types of stroke); primary stroke centers (which provide 24/7 specialized care mainly for ischemic stroke); and acute stroke-ready hospitals (which can evaluate and treat most strokes but lack highly specialized capabilities), and community hospitals.
"This is the first time we've brought these healthcare elements together -- including community hospitals which may lack onsite stroke expertise -- which reflects the emerging role of telemedicine in these hospitals," Jauch said.
Among other major revisions to the guidelines, if feasible, patients should be transferred rapidly to the closest available certified primary care stroke center or comprehensive stroke center, which might involve air medical transport.