ITEMS IN AFP WITH MESH TERM:
Tissue Plasminogen Activator
ABSTRACT: Successful treatment of patients with ischemic stroke depends on the ability to treat within three hours of onset, because tissue plasminogen activator has not yet been proved effective beyond this time frame. The two major causes of delay in treatment are failure, on the part of the patient or family, to recognize stroke symptoms and failure to access the medical system most efficiently--by calling 911. Hospital stroke teams can shorten the time between patient arrival at the emergency department and treatment. Guidelines for the evaluation and treatment of potential stroke patients are presented, along with goal times for arrival-to-treatment intervals.
ABSTRACT: Optimal treatment of the patient who has sustained an acute ischemic stroke requires rapid assessment and early intervention. The leisurely approach to acute stroke management sometimes taken in the past should be replaced by an approach that treats stroke as a true medical emergency. Thrombolysis with tissue plasminogen activator has been labeled for the treatment of acute ischemic stroke, but it must be given within three hours of stroke onset. However, fibrinolytic therapy can be given safely to only a fraction of patients with acute stroke, and more broadly applicable therapies are needed. Recent evidence does not support the routine use of heparin in patients with acute stroke, and early use of aspirin offers only modest benefit. Neuroprotective therapies designed to interfere with cytotoxic events initiated by ischemia are undergoing clinical trials that should be completed within the next year. At present, only tissue plasminogen activator has been labeled for acute stroke treatment; however, other agents are on the horizon, and much can be done supportively to improve neurologic outcome. Because of the unique susceptibility of neurons to ischemia, minutes count. Thus, hospitals providing care for patients with acute stroke should organize clinical protocols and pathways for effective implementation of therapies.