The whole article doesn't even address why all persons getting this quickly don't recover. If you don't recognize the problem you can't solve it. I got it in 90 minutes and still ended up with lots of motor problems. Shouldn't the goal be to eliminate disability by providing drugs that stop the stroke and then also stop the inevitable neuronal cascade of death?
http://www.alphagalileo.org/ViewItem.aspx?ItemId=144233&CultureCode=en
Many more stroke patients could benefit from thrombolytic treatment
(the use of drugs to break up or dissolve blood clots), but it needs to
be administered as quickly as possible after the first signs of illness,
according to new findings from the largest meta-analysis to date
investigating the clot-busting drug alteplase. The study, which
involved more than 6700 stroke patients, is published in The Lancet.
The emergency treatment with alteplase markedly improves the chances
of a good outcome when administered within 4·5 hours of onset of
symptoms but, although still worthwhile, its benefit diminishes the
later it is given.
The findings show just how important it is for people with acute
ischaemic stroke (in which blood flow to an area of the brain is blocked
or reduced) to be identified quickly and treated by specialist staff in
order to reduce the subsequent degree of disability.
“Our results show that alteplase treatment is a very effective means
of limiting the degree of disability in stroke patients”*, said study
co-author and senior statistician Dr Jonathan Emberson, from the
Clinical Trial Service Unit at the University of Oxford in the UK.
Dr Emberson and colleagues conducted a meta-analysis of individual
patient data from all the major trials of alteplase for treatment of
acute ischaemic stroke. Analysis of data from nine randomised trials
involving 6756 patients (1729 older than 80 years of age) showed that
alteplase treatment significantly increased the odds of a good stroke
outcome (no significant disability 3–6 months after stroke), with faster
treatment offering the best chance of recovery.
The odds of a good stroke outcome were 75% greater for patients given
alteplase within 3 hours of initial stroke symptoms, compared with
those who did not receive the drug; for those given the drug between 3
and 4·5 hours post-stroke there was a 26% increased chance of a good
outcome; while for those with a delay of more than 4·5 hours in
receiving treatment, there was just a 15%, not statistically
significant, increase in the chance of a good recovery.
According to Dr Emberson, “Although alteplase increased the risk of
death from intracranial haemorrhage by about 2% within the first few
days after stroke, by a few months survivors treated with alteplase were
less likely to be disabled than those not receiving such treatment.
Indeed, alteplase increased the proportion who avoided disability
altogether by about 10% for patients treated within 3 hours and 5% for
those treated between 3 and 4·5 hours.”*
According to Kennedy Lees, study co-author and Professor of
Cerebrovascular Medicine at the University of Glasgow, UK, “What this
shows is that we are up against the clock when treating ischaemic
stroke. Every minute counts. People need to be identified quickly and
systems need to be in place to get them scanned, diagnosed accurately,
and then treated within minutes to hours.”*
Importantly, the benefits of alteplase were observed in all patient
groups studied, including those aged 80 or over and those with severe
strokes. Richard Lindley, Professor of Geriatric Medicine at the
University of Sydney, and a study co-author added, “These results
demonstrate that upper age limits in clinical trials can inadvertently
lead to the elderly being excluded from an effective treatment. These
new results tell us that the elderly should be treated with the same
urgency as younger patients.”*
Study co-author Peter Sandercock, Professor of Neurology, University
of Edinburgh said, “I cannot over-emphasise how useful these analyses
are—they provide the type of clear information that patients and their
families need when weighing the benefits and risks of this important
treatment.”*
Writing in a linked Comment, Michael Hill and Shelagh Coutts from the
Hotchkiss Brain Institute and Department of Clinical Neurosciences,
Calgary, Canada, point out that, “The data render obsolete the European
licensing label for alteplase—which excludes patients older than 80
years and those with severe stroke. The finding of a small benefit of
treatment up to 4·5 h from onset makes the advice of the US Food and
Drug Administration and Health Canada to not treat patients after 3 h
from onset similarly outdated.”
They add, “The question now is not whether we can extend the window
for treatment. Rather, how do we get everyone treated faster and how do
we dispel preconceived notions about not treating older patients or
those with milder strokes?…Audits show that patients with ischaemic
stroke are offered thrombolysis too rarely or, if they are offered it,
too slowly. Quick treatment requires efficient processes and a team
approach. Pre-hospital systems to identify patients and bring them to
the appropriate hospitals, emergency department swarming, rapid simple
imaging, and use of telemedicine must be harnessed to reduce times to
treatment. Strategies to do so will vary by region but it is simply
unacceptable not to achieve very fast treatment times.”
*Quotes direct from authors and cannot be found in text of Article.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)60584-5/abstract
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