Clot busters long have been used to help stoke victims avoid devastating, even fatal outcomes.
Most recently, the world became aware of their effectiveness when the tissue plasminogen activator, or tPA, was used to help Houston Texans football coach Gary Kubiak after he suffered a stroke during halftime of his NFL team’s nationally televised game Nov. 3.
“The drug overall is effective,” said Dr. Tarun Bhalla, a Geisinger Health Center neurological surgeon.
Kubiak quickly was rushed to an area hospital in Houston where he was administered the drug.
Bhalla noted that quick intervention for treating a stroke often is the key to avoiding more severe complications.
Strokes involve either blockage of an artery to the brain (ischemic) or bleeding into the brain (hemmorhagic).
Some people who experience the more common ischemic stroke can benefit from the injection of a tPA, usually through a vein in the arm.
TPA is an enzyme found naturally in the body that converts plasminogen into another enzyme to dissolve a blood clot and help re-establish blood flow to the brain, according to the National Stroke Association.
In 1996, tPA became the first acute ischemic stroke treatment to be approved by the Food and Drug Administration.
Bhalla noted the drug, available in most hospitals with primary stroke clinics, is normally administered intravenously.
Unfortunately, the drug is not used often enough for stroke victims.
A big reason, he said, is the long delay that often occurs from the onset of stroke symptoms to when the drug can be administered.
Given the rural population of central Pennsylvania, many stroke victims live in remote areas and cannot be quickly reached by emergency responders and te readily transported to a health care center.
“It cannot be used after the three-hour window after onset of stroke,” he said.
And while most hospitals can administer tPA in the emergency room, very few have the equipment and physicians to use it inter-cranially, a technique that allows for more time between the onset of stroke symptoms and tPA treatment.
There also is a major drawback to the drug.
“The major side effect is bleeding into the site of the stroke. There really is no concrete way to prevent that. It’s a risk you take in giving the drug,” Bhalla said.
A National Institute of Neurological Disorders and Stroke study indicated that eight of 18 stroke patients who receive tPA according to a strict protocol will recover by three months after the event without significant disability. That compares to six of 18 stroke patients who recover substantially regardless of treatment.
Bhalla said it’s important to know the symptoms of a stroke which include weakness on one side of the body, weakness or numbness in the arm, slurred speech or trouble talking.
Stroke care, he noted, doesn’t stop with clot busters.
To decrease one’s chance for future strokes, procedures can be performed to open up an artery that’s moderately to severely narrowed by plaque.
A carotid endarterectomy is the removal of plaque from the carotid arteries running along each side of the neck to the brain.
An angioplasty involves the insertion of a catheter with a stent and balloon into an artery of the groin and guided to the blocked carotid artery in the neck. The balloon is inflated in the narrowed artery and the stent used to keep the artery from narrowing following the procedure.
High blood pressure, high cholesterol, diabetes, tobacco use and smoking, alcohol use, obesity, physical inactivity, atrial fibrillation and atherosclerosis each increase one’s chances for stroke.
Stroke is the third leading cause of death in the U.S., and each year more than 750,000 people have a new or recurrent stroke, according to the National Stroke Association.
The good news is that about 80 percent of strokes are preventable.