Tuesday, February 12, 2013

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.”

About Loyola University Health System

Loyola University Health System (LUHS) is a member of Trinity Health. Based in the western suburbs of Chicago, LUHS is a quaternary care system that includes Loyola University Medical Center (LUMC), located on a 61-acre campus in Maywood, Gottlieb Memorial Hospital (GMH), on a 36-acre campus in Melrose Park, and convenient locations offering primary and specialty care services throughout Cook, Will and DuPage counties. At the heart of LUMC is a 547-licensed-bed hospital that houses the Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, a burn center, a children's hospital, Loyola Outpatient Center, and Loyola Oral Health Center. The campus also is home to Loyola University Chicago Stritch School of Medicine, Loyola University Chicago Marcella Niehoff School of Nursing and the Loyola Center for Fitness. The GMH campus includes a 254-licensed-bed community hospital, a Professional Office Building with 150 private practice clinics, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park.

Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation. It serves people and communities in 22 states from coast to coast with 93 hospitals, and 120 continuing care locations — including home care, hospice, PACE and senior living facilities — that provide nearly 2.5 million visits annually.