Neurology Residents At Ease With Clot Busters

tPA reduces the rate of disability after stroke

August 8, 2011 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Clot busting drugs reduce stroke disability, yet patients often don't receive the treatment. It appears that graduating neurology residents are becoming more comfortable with using the drug.

The number of neurology residents at ease treating stroke with clot-busting drug tissue plasminogen activator (tPA) rose to 94 percent in 2010.

"Request tPA after an ischemic stroke."

Dr. Brett Cucchiara, senior author of the study and an assistant professor of neurology at the Hospital of the University of Pennsylvania, said it is critical that neurology residents get comfortable using tPA so that they can use it in clinical practice and guide other doctors about its use.

Discomfort with using tPA among neurology residents is understandable, because the medication has serious risks associated with it, despite it's potential to save serious disability. If used in the wrong type of stroke, such as in a hemorrhagic stroke instead of an ischemic stroke, the results can be fatal. Often times, this determination can't be made within the required window of time. 

The National Institute of Neurological Disorders and Stroke (NINDS) study found that one out of every 18 patients who received tPA experienced bleeding in the brain, and 45% of those patients would die from it. In addition, bleeding can be caused in other areas of the body as well, such as the intestines. So while the drug can greatly help people having an ischemic stroke, it's use must be carefully applied.

In 2000, only 73 percent of residents were comfortable using tPA. Additionally, 95 percent of graduating residents said they has used the clot-busting drug as compared to 80 percent in the study a decade ago. Of those residents who had previously used tPA, 59 percent reported using it in at least one instance without direct faculty supervision.

The clot-busting drug was approved by the U.S. Food and Drug Administration in 1996. It has been proven to reduce the rate of disability after stroke if given within three to four and a half hours after stroke symptoms appear. But previous research has shown that less than 10 percent of ischemic stroke patients receive tPA.

Reasons that were given for its low use were late arrival at the hospital and lack of doctor confidence in using tPA.

The responses from the 286 neurology residents also showed that the number who have observed tPA increased from 88 percent to 99 percent. Additionally, those with formal training in the National Institutes of Health stroke scale increased from 65 percent to 93 percent, and the number reporting their hospital has dedicated stroke teams increased from 84 percent to 93 percent.

The research was published in Stroke: Journal of the American Heart Association.