BREAKING NEWS : Allen County coroner identifies cyclist killed after being hit by car on Lima Road Full Story
BREAKING NEWS : Allen County coroner identifies downtown Washington Boulevard crash victim Full Story
BREAKING NEWS : Allen County coroner identifies Hawthorn Suites shooting victim Full Story

Doctors have more time than thought to treat stroke patients, study suggests

Time is the most crucial element when it comes to treating patients who are experiencing a stroke -- and a new study suggests that that crucial window could...

Posted: May 9, 2019 8:42 AM

Time is the most crucial element when it comes to treating patients who are experiencing a stroke -- and a new study suggests that that crucial window could be a little longer than previously thought.

Thrombolytic medicine, which helps break up blood clots, typically is administered to treat an ischemic stroke within 4½ hours of the start of symptoms.

Yet the study, published in The New England Journal of Medicine on Wednesday, suggests that treatment between 4½ and nine hours after stroke symptoms emerged still could offer benefit.

A thrombolyic drug called alteplase is the only medication approved by the US Food and Drug Administration to treat acute ischemic stroke and is administered through an IV. Most strokes, about 87%, are ischemic strokes, which occur when the artery that supplies oxygen-rich blood to the brain gets blocked, often by a collection of blood called a clot.

Even though the new study findings are "exciting," Dr. Carmelo Graffagninob, a vascular neurologist at Duke Health and medical director of the Duke Comprehensive Stroke Center in Durham, North Carolina, pointed out that the American Stroke Association and other medical groups have not weighed in as far as making formal changes to stroke treatment guidelines.

With additional research, however, that could happen.

"What was really exciting is that in vascular neurology, or stroke, we were forever stuck with treating patients by the clock rather than by what was actually going on in their brain," said Graffagnino, who was not involved in the study but saw parts of the research presented at the International Stroke Conference in February.

"We think this is just the beginning of using biology and not the clock to treat the right patients," he said.

In the United States, someone has a stroke every 40 seconds, according to the US Centers for Disease Control and Prevention.

A benefit for rural or low-income health centers

The new study involved 225 adults who had strokes between 2010 and 2018 in Australia, New Zealand, Taiwan and Finland.

The patients were randomly assigned to receive either a thrombolytic therapy or placebo between 4½ and nine hours after the onset of their strokes.

The researchers found that recanalization, or restoration of blood flow, was achieved at 24 hours after the stroke in 67.3% of the patients in the therapy group, compared with 39.4% in the placebo group.

The study also found that the degree of disability after the stroke, measured on what's called a modified Rankin scale, was zero or minimal among more patients in the therapy group, at 35.4%, compared with the patients in the placebo group, at 29.5%.

The percentage of patients who died within 90 days of treatment or placebo did not differ significantly between the groups, according to the study.

"About 80% of the patients in this trial had large vessel clots, which means that they would actually be candidates for mechanical thrombectomy -- for pulling the clot out using a catheter -- and the success rate of pulling a clot out by catheter is much higher than the success rate of dissolving a clot with a medication," Graffagnino said.

If a patient may not have access to thrombectomy, however, the study suggests that thrombolysis could be a beneficial option.

"This has really big implications for more distal places, more rural hospitals that are quite far from an advanced treatment center, for low- or middle-income countries where interventions, such as thrombectomy, are limited due to their resources," he said.

Globally, about 70% of strokes and 87% of both stroke-related deaths and disabilities occur in low- and middle-income countries, according to the World Health Organization.

The new study had some limitations, including a sample size smaller than intended, because the research was terminated early after positive results from a previous trial were published.

'The era of time-based treatment ... may finally be drawing to a close'

The new study "reinforces the importance of individualizing acute stroke treatment and not simply excluding patients because of the time they were last seen normal," Dr. Fadi Nahab, medical director for the Stroke Program at Emory University Hospital, who was not involved in the study, wrote in an email.

Many hospitals offer IV alteplase only if a patient experienced stroke symptoms within 4½ hours and exclude those who may have awoken from sleep with stroke symptoms because the onset time would be unknown, Nahab said.

So the extension of that time window provides "stroke center hospitals with additional opportunities to treat patients who come in within 4.5 to nine hours or who develop new stroke symptoms on awakening from sleep," he said.

Even though more research is needed to validate the study's findings, "the era of time-based treatment with intravenous alteplase in patients with acute stroke may finally be drawing to a close," Dr. Randolph Marshall, a neurologist at Columbia University in New York, wrote in an editorial published alongside the new study.

"As of 2013, only 6.5% of patients hospitalized for ischemic stroke in the United States received intravenous thrombolysis treatment," he wrote. "Extending the time window for treatment could result in greater numbers of patients eligible to receive treatment for acute stroke."

Indiana Coronavirus Cases

Data is updated nightly.

Cases: 595436

Reported Deaths: 9466
CountyCasesDeaths
Marion822851311
Lake44626670
Allen32165543
Hamilton28684308
St. Joseph26917378
Elkhart24173343
Vanderburgh18856236
Tippecanoe17638125
Johnson14687289
Porter14513163
Hendricks14010242
Madison10715216
Vigo10540177
Clark10349135
Monroe9189108
Delaware8956134
LaPorte8867158
Howard7982140
Kosciusko791380
Warrick652994
Hancock646999
Bartholomew631096
Floyd6205107
Wayne5984159
Grant5874110
Dubois547175
Boone538867
Morgan524192
Henry497764
Marshall495384
Cass475362
Dearborn464545
Noble463157
Jackson417846
Shelby405680
Lawrence383876
Clinton367840
Gibson360058
DeKalb339163
Montgomery338152
Harrison333643
Knox329839
Miami312743
Steuben309343
Adams297435
Whitley297225
Wabash294947
Ripley294345
Putnam288047
Jasper285234
Huntington284959
White269138
Daviess263073
Jefferson253838
Decatur243482
Fayette242948
Greene237062
Posey234427
Wells231347
LaGrange225061
Clay219032
Scott218538
Randolph209845
Jennings193935
Sullivan189632
Spencer184319
Fountain180527
Washington179321
Starke172743
Jay163922
Fulton161130
Owen161137
Carroll153915
Orange152933
Rush151618
Perry149327
Vermillion145833
Franklin144433
Tipton129232
Parke12918
Pike114326
Blackford109222
Pulaski95337
Newton89821
Brown85931
Benton85310
Crawford7719
Martin70713
Warren6637
Switzerland6235
Union6146
Ohio4727
Unassigned0374

Ohio Coronavirus Cases

Data is updated nightly.

Cases: 836049

Reported Deaths: 10323
CountyCasesDeaths
Franklin98533705
Cuyahoga831801065
Hamilton61931441
Montgomery42028399
Summit33849736
Lucas30524605
Butler30003228
Stark25093419
Warren19083140
Lorain18418212
Mahoning16931337
Lake15592136
Clermont15335105
Delaware1403077
Licking12819132
Trumbull12515307
Fairfield1232480
Greene11729135
Medina11286165
Clark10672264
Wood10081156
Allen9639126
Portage9006107
Miami895273
Richland8910116
Marion7377113
Tuscarawas7177174
Columbiana7164124
Pickaway710350
Wayne6855165
Muskingum678241
Erie5976118
Hancock542990
Ross535287
Scioto527063
Geauga491755
Darke459489
Ashtabula443172
Lawrence439353
Union437028
Sandusky427462
Mercer427387
Seneca417357
Auglaize416259
Huron416138
Shelby413521
Jefferson409066
Belmont403740
Washington375940
Putnam367872
Athens36759
Madison343429
Knox340122
Ashland336838
Fulton328543
Defiance322578
Crawford316371
Preble313836
Brown298819
Logan296529
Ottawa283934
Clinton281243
Williams272866
Highland266018
Jackson259043
Guernsey245325
Champaign244427
Fayette229729
Morrow22574
Perry223318
Holmes220362
Henry213547
Hardin206433
Coshocton199620
Van Wert198744
Wyandot192549
Gallia192126
Adams167415
Pike167417
Hocking165523
Carroll151316
Paulding141121
Noble118740
Meigs105021
Monroe97229
Harrison8598
Morgan79728
Vinton67613
Unassigned00
Fort Wayne
Clear
26° wxIcon
Hi: 30° Lo: 23°
Feels Like: 16°
Angola
Partly Cloudy
25° wxIcon
Hi: 27° Lo: 21°
Feels Like: 13°
Huntington
Partly Cloudy
28° wxIcon
Hi: 31° Lo: 23°
Feels Like: 17°
Fort Wayne
Clear
26° wxIcon
Hi: 30° Lo: 24°
Feels Like: 16°
Lima
Partly Cloudy
27° wxIcon
Hi: 30° Lo: 23°
Feels Like: 17°
Sunshine, Warmer Thursday
WFFT Radar
WFFT Temperatures
WFFT National

Community Events