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Study Shows that Rapid Treatment Reduces Risk of In-Hospital Death Caused by Stroke

A study of patients diagnosed with acute ischemic stroke who received intravenous thrombolysis showed that more rapid treatment reduced the rate of in-hospital deaths and symptomatic intracranial hemorrhage and increased the rate of patients who were walking independently at discharge or discharged to home.

The study includes data from 58,353 patients who received tissue plasminogen activator (tPA) within 4.5 hours of acute ischemic stroke symptom onset at 1,395 hospitals that participate in the American Heart Association/American Stroke Association Get With The Guidelines (GWTG®)-Stroke Program. The median (midpoint) age of the patients was 72 years. The study was published in the June 19, 2013 issue of The Journal of the American Medical Association and was coordinated by Jeffrey L. Saver, M.D., of the David Geffen School of Medicine at UCLA, Los Angeles.

South Nassau Communities Hospital was recently presented the GWTG Stroke Gold Plus Quality Achievement Award for a second consecutive year and is a member of the GWTG’s Target: Stroke Honor Roll for improving stroke care. To qualify for the honor roll, a minimum of 50 percent of the hospital’s eligible ischemic stroke patients must have received tPA within 60 minutes of arriving at the hospital (known as ‘door-to-needle’ time).

A thrombolytic, or clot-busting agent, tPA is the only drug approved by the U.S. Food and Drug Administration for the urgent treatment of ischemic stroke. If given intravenously in the first few hours after the start of stroke symptoms, tPA has been shown to significantly reverse the effects of stroke and reduce permanent disability. Unfortunately, tPA therapy is not an option for patients who are having a hemorrhagic stroke (which is when a blood vessel in the brain leaks or bursts) or have one or more of the following conditions: bleeding ulcer, blood clotting problems, brain cancer, extremely high blood pressure, prior bleeding problems.

The researchers found that for every 15 minute faster onset to treatment interval, in-hospital mortality was less likely to occur, symptomatic intracranial hemorrhage was less likely to occur, independence in ambulation at discharge was more likely to occur, and discharge to home was more likely to occur. For patients treated in the first 90 minutes, compared with 181-270 minutes after onset, in-hospital mortality was 26 percent less likely to occur, symptomatic intracranial hemorrhage was 28 percent less likely to occur, independence in ambulation at discharge was 51 percent more likely to occur, and discharge to home was 33 percent more likely to occur.

According to the American Heart Association/American Stroke Association, stroke is the fourth-leading cause of death in the United States and a leading cause of serious, long-term disability. On average, someone has a stroke every 45 seconds; someone dies of a stroke every three minutes; and 795,000 people have a new or recurrent stroke each year. All of the major symptoms of stroke may appear suddenly and without warning and they are often not painful. The most common symptoms of stroke can be remembered by the acronym FAST:

F = Face: Is one side of the face drooping down? A = Arm: Can the person raise both arms, or is one arm weak? S = Speech: Is speech slurred or confusing? T = Time: Time is critical!! Call 9-1-1 immediately! Other less common symptoms of stroke are sudden trouble seeing, sudden dizziness, and difficult to pin-point weakness or non-specific weakness. If you or someone you are with is experiencing some or any of these symptoms, call 9-1-1 immediately.

According to Dr. Saver it’s important that people know that stroke is now highly treatable, but that every minute counts. “So if symptoms occur suddenly, call 911 to get to the hospital right away. It takes up to 60 minutes in even the best hospitals to perform the needed imaging tests and blood work before administering tPA," he added.

South Nassau’s Emergency Services Department is designated a regional Stroke Center by the New York State Department of Health and has Advanced Certification for Primary Stroke Centers from The Joint Commission. Including highly skilled, board-certified physicians with expertise in treating stroke, the department provides:

  • Rapid assessment of patients with stroke symptoms
  • On-site new generation CT scanner that minimizes radiation exposure
  • Prompt treatment using advanced therapies and procedures
  • Comprehensive neurological and neurosurgical care throughout hospitalization
  • Nurses with special training in stroke care

  • As southern Nassau’s only Trauma Level II Center, the department has over 35 large independent treatment bays and specialty areas including Pediatrics and Behavioral Health as well as its own dedicated Digital Radiology suite for rapid access for testing and results.

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