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A Vexing Issue in Stroke Care: When to Use Clot-busting Drugs?

MAYWOOD, Ill. – One of the most challenging issues in stroke care involves the use of clot-busting drugs such as tPA.

When given quickly enough and to the right patient, such drugs can minimize stroke damage by dissolving blood clots that cause most strokes. But these blood-thinning drugs also increase the risk of brain hemorrhages and other complications.

In an article in the journal Expert Review of Neurotherapeutics, Loyola University Medical Center stroke specialists offer guidance on commonly asked questions about the use of these drugs, known as thrombolytic therapy.

The authors are H. Steven Block, MD, and José Biller, MD. Block, a neurologist with 30 years of experience, is doing a fellowship at Loyola in cerebrovascular disease research. Biller is a professor and chair of the Department of Neurology at Loyola University Chicago Stritch School of Medicine.

Most strokes are caused by blood clots that block blood flow to a portion of the brain. If given within 4.5 hours of the onset of a stroke, drugs such as tPA can reduce damage by restoring blood flow to the affected part of the brain. In various circumstances, neurologists must weigh the benefits of tPA against the risks of hemorrhage and other complications.

Block and Biller address these questions in their article:

  • Can thrombolytic therapy be administered in a patient with an aneurysm (bulging blood vessel) in the brain that hasn’t ruptured?
  • Is it safe to use thrombolytic therapy in a stroke patient following a recent heart attack?
  • Is there a standard, defined therapy for a stroke that occurs during or immediately after a cardiac catheterization?
  • Can thrombolytic therapy be used in stroke patients with brain tumors?

“These are examples of the type of nuanced circumstances that neurologists face,” Block said.

Block and Biller write that the next five years should bring continued advances in stroke care.

“Large multicenter, prospective, randomized, controlled trials will move us closer to increasing confidence of the efficacy of specific treatments,” they write. However, the most important advance in reducing the incidence of stroke will “continue to remain one of the most challenging to achieve: acceptance by the population to take personal responsibility for their own stroke-risk reduction.”

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and more than 30 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus is a 559-licensed-bed hospital that houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children's Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola's Gottlieb campus in Melrose Park includes the 255-licensed-bed community hospital, the Professional Office Building housing 150 private practice clinics, the Adult Day Care, the Gottlieb Center for Fitness, Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

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Jim Ritter
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