Many Hospital Patients Arriving Too Late For Stroke Drug

Most stroke patients arrive at the hospital too late to take advantage of a clot-busting drug that significantly reduces stroke symptoms and lessens the chance of permanent disability if delivered within three hours of the onset of symptoms.

New research by the Yale School of Public Health found that while hospitals are more frequently delivering tissue-type plasminogen activator (t-PA) to ischemic stroke patients, the proportion of patients arriving in time to benefit from the drug changed little over a three-year period.

Lead researcher Judith H. Lichtman, Ph.D., associate professor in the division of Chronic Disease Epidemiology, said the findings suggest that more needs to be done to educate people about stroke symptoms and the importance of receiving prompt medical care. Patients generally need to be at the hospital within two hours of symptoms to provide enough time for testing and for t-PA to be administered.

“One of the greatest challenges for acute stroke care is getting patients to the hospital as soon as possible once they experience stroke symptoms, so that therapy is given within the treatment window” Lichtman said. The study results are published this month in Stroke: Journal of the American Heart Association.

The study reviewed the medical records of 428 patients from 2001 and 481patients from 2004 who were treated at one of more than 30 academic medical centers in the United States. In both years only about 37 percent of all stroke patients arrived at the hospital in time and black patients were 44 percent less likely than white patients to arrive at the hospital within two hours of symptoms. The study also found that hospital use of the drug is increasing, with 37.5 percent of eligible patients receiving the drug in 2004, up from 14 percent in 2001.

“Almost two-thirds of patients are not even making it to the hospital in time to be eligible for t-PA, which is a great public health concern,” she said. “Targeted educational campaigns such as the American Stroke Association’s Power to End Stroke may be critical to target patients at high-risk for delays in seeking care.”

The drug is the only one approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke.

“We need to get better at educating the public about how to recognize the signs and symptoms of stroke. This means not only improving awareness, but also changing behaviors so people who are suspicious that they are having a stroke seek immediate medical care,” Lichtman said.

Stroke warning signs include sudden numbness or weakness in the face, arm or leg, especially on one side of the body; confusion, trouble speaking or understanding; trouble seeing in one or both eyes; and trouble walking, dizziness, loss of balance or coordination.