Sea Change Expected in Hospital Treatment of Stroke

By Carrell, Steve | Drug Topics, February 19, 1996 | Go to article overview

Sea Change Expected in Hospital Treatment of Stroke


Carrell, Steve, Drug Topics


Stay tuned for new hospital stroke teams (including pharmacists), big alterations in stroke treatment, major changes in emergency care, plus more news to come.

Much of the hoopla at the recent American Heart Association's annual stroke conference stemmed from a federal study showing t-PA as the first treatment for acute stroke (see article in Drug Topics, Jan. 22, based on an article in the New England Journal of Medicine). But many experts, including conference chairman David Sherman, M.D., and Harold Adams Jr., M.D., head of AHA's stroke council, were reserving wholehearted endorsement of t-PA until the stroke conference was held in San Antonio in late January. Then supportive studies and plaudits from neurologist stroke experts worldwide bolstered the big-time drum-banging.

"People have been wanting to know the neurologic stroke community's consensus on t-PA. Putting all the trials together at this meeting, that [supportive] consensus has come out. The NIH study [alone] was so consistently positive that I'd unequivocally say t-PA is a proven effective therapy for [selected patients with] acute stroke," said Sherman, a professor and chief of neurology at the University of Texas Health Science Center at San Antonio.

But to make t-PA work, a hospital needs a coordinated treatment team; the best results occur when a patient receives t-PA within three hours after stroke. Hospitals in the study had someone in the emergency department, usually a nurse or physician, to activate other team members' beepers when a potentially qualified patient. appeared. If t-PA was not stored in the emergency department, a pharmacist began preparing the drug, sometimes even before the need was confirmed. Meanwhile, stat blood work and a CT scan helped provide diagnostic criteria. A physician, usually a neurologist or trained emergency physician, read the information and decided whether to give t-PA. Then the patient received extremely close monitoring in the intensive care unit, because t-PA has potentially dangerous hemorrhagic side effects.

At a news conference in San Antonio, several researchers said their teams' best performance was 20-30 minutes, but the process usually took an hour. Acknowledging that all hospitals cannot muster such a team, especially at night, researchers suggested designating certain hospitals as regional stroke centers.

But hospitals must consider the cost of the new treatment. For instance, one study site, Henry Ford Hospital in Detroit, is analyzing the higher immediate costs versus the economic benefits of preventing long-term disability or death, said study researcher Steven Levine, M.D., the hospital's stroke unit director. …

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