Not a moment to lose in therapy for acute stroke

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In an editorial response to a report in the September 25 issue of the New England Journal (NEJM) on the efficacy of intravenous thrombolysis therapy in the hours after acute ischemic stroke, Patrick Lyden, M.D., professor of neurosciences and director of the UC San Diego Stroke Center, cautions that the study should not be interpreted to mean that such treatment can be withheld for hours or even minutes.

"The risk of withholding such therapy from patients with acute stroke greatly exceeds the risk of giving it," said Lyden. "The potential for reversing the disabling side effects of stroke declines with every passing minute".

The study, ("Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke") by Werner Hacke, M.D. et al, reports the findings from the European Cooperative Acute Stroke Study III (ECASS III).

The design of this study closely mirrored that of the original National Institute of Neurological Disorders and Stroke (NINDS) trial of recombinant tissue plasminogen activator (rt-PA) for acute stroke, a pivotal trial that Lyden helped lead that showed the first proven treatment for stroke. The important exception in the ECASS III trial is that the window of treatment was expanded to a period of three to four and a half hours, in comparison to under three hours in the NINDS trial.

As per Lyden, the very real peril of the BCASS III data is that some may take a slower approach to treating acute stroke.

"Nothing could be more wrong," Lyden states in the editorial. "As we look back on the past decade of thrombolytic treatment for stroke, it is very clear that our focus must remain on the door-to-needle time. Every minute matters during a stroke".


Posted by: Daniel    Source