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Stroke treatment window stays open longer than thought, say Stanford researchers

STANFORD, Calif. - After a stroke, a person typically has just three hours to reach a hospital and receive the one drug approved to help save threatened brain cells. This narrow treatment window limits the drug's usefulness to less than one-quarter of all stroke patients who squeak in under the deadline. A new study published in the March 6 issue of The Lancet suggests this treatment window may remain open longer, but also highlights the importance of getting treated as quickly as possible.

"The sooner you treat the patient the better the chance that they will have a good recovery from the stroke," said Gregory Albers, MD, professor of neurology and neurological sciences at Stanford University School of Medicine and director of the Stanford Stroke Center. Albers was one of the main authors of the report.

Albers said this study sends two messages to doctors who treat stroke patients. The first is that patients should receive a clot-busting drug called tPA as soon as possible after arriving at the hospital.

"In routine clinical practice it is common for patients to be treated right at the end of the three-hour limit, even if they arrived at the hospital within an hour of the stroke," Albers said. The study recommends that all hospitals try to administer tPA treatment within an hour of a stroke patient's arrival.

The second message is that tPA appears to be effective even after the three-hour time period passes, though it is less effective than when given earlier.

This study combined data from six previous studies looking at tPA's effectiveness compared to a placebo. Two studies included patients who received tPA up to three hours after the stroke, and the other four studies went out to five or six hours. Taken on their own, the five- to six-hour trials didn't find any convincing benefit to giving tPA after three hours, but none had enough patients to be conclusive. The researchers who led these trials decided to pool individual
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Contact: Amy Adams
amyadams@stanford.edu
650-723-3900
Stanford University Medical Center
4-Mar-2004


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