A Johns Hopkins study has shown that patients treated for a type of stroke caused by bleeding in the brain, or intracerebral hemorrhage, survived more often if given 1 milligram instead of the previously studied 3 milligram dose of the clot-busting drug tissue plasminogen activator (tPA). In the study, Daniel Hanley, M.D., a professor and neurologist at The Johns Hopkins University School of Medicine, demonstrated that rates of continued bleeding and subsequent death can be reduced if the tPA dosage is lowered to 1 mg.

"We have good evidence that lower doses of tPA not only worked as well as the higher dose, but also markedly reduced side effects in regard to bleeding," Hanley said. "Ten years ago, the mortality rate for this type of stroke was at 80 percent. One year ago, it was 50 percent. In this study it was 13 percent."

Hanley will present the study at the International Stroke Conference on Feb. 18 in Kissimmee, Fla.

An intracerebral hemorrhage -- bleeding in the brain -- is the only type of stroke without a clearly defined treatment. It occurs in more than 100,000 Americans each year. Up to half of patients die, and those who survive suffer significant disabilities. During such a stroke, blood often extends into the ventricles, small chambers in the brain where cerebrospinal fluid is made, increasing the chances of damage.

In a previous study by Hanley and his group of 26 patients, a 3 milligram dose of tPA could be used safely to treat this type of stroke, reducing the mortality rate to 19 percent. However, continued bleeding was observed in 23 percent of the patients. This new study was designed to find ways to reduce bleeding and further improve patient outcomes.

Researchers studied 16 patients who received either 0.3 milligram or 1 milligram of tPA every 12 hours through a catheter for up to four days or until the ventricles opened. The patient groups were balanced with respect to age, gender, initial stroke severity
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Contact: Eric Vohr
evohr1@jhmi.edu
410-955-8665
Johns Hopkins Medical Institutions
17-Feb-2006

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