Study Indicates 3-hour Window for Stroke Treatment Could Lengthen

Research published in the Sept. 25, 2008 issue of the New England Journal of Medicine suggests that physicians might have slightly more time to treat acute ischemic stroke than previously thought. The current standard of care is to use the FDA-approved drug tPA (alteplase) within the first three hours of stroke onset if the stroke can be determined to be ischemic, rather than hemorrhagic.

The European Cooperative Acute Stroke Study (ECASS), which involved 821 patients, studied the efficacy and safety of administering tPA between 3 and 4½ hours following stroke onset. Researchers found that more patients (52.4 percent) had a favorable outcome with the treatment than with a placebo (45.2 percent). On the downside, the risk of symptomatic intracranial hemorrhage, as defined by the study, was higher for those treated with tPA (2.4 percent) than those given a placebo (0.2 percent).

As a result of the study, treatment protocols at the University of Cincinnati Gardner Neuroscience Institute are being discussed, says the institute’s research director, Joseph Broderick, M.D., an internationally known stroke expert and Chair of UC’s Department of Neurology. “It’s something we’re considering, but it’s complicated,” Dr. Broderick says. “We’re looking at it very carefully, and we’re also awaiting additional data from the trial.”

A stroke, or brain attack, is always an emergency. Anyone seeing or experiencing symptoms of a stroke should call 911 immediately to activate the local emergency response team. As the ECASS investigators have stated: “Having more time does not mean that we should be allowed to take more time.”

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