May 23, 2018
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Wake-up stroke victims can receive clot-busting drugs, study says

By Shari Roan, Los Angeles Times

LOS ANGELES — Stroke victims who are treated with blood-clot dissolving medications often recover better than people who don’t receive the drugs. The medications, called tissue plasminogen activators, must be given within 4.5 hours of the first symptoms of stroke. Many people arrive at the hospital too late for the therapy.

One such group are people who wake up with symptoms of stroke and have no idea when their symptoms began. Now, however, research is suggesting that “wake-up” stroke patients should be treated with tPA.

Doctors typically avoid giving tPA to “wake-up” stroke victims because of safety concerns. The medications can cause bleeding in the brain. But the new study compared 326 patients who received the medications within 4.5 hours of the first stroke symptoms to 68 wake-up stroke patients who were also treated with tPA. Three months after the treatment patients in both groups had similar results in terms of death rates, risk of brain bleeding and recovery from the stroke.

As many as 20 percent of strokes are “wake-up” strokes, the authors said. Thus, the use of tPA in this group of people could be significant.

The study, presented Wednesday at the American Stroke Association’s International Stroke Conference in New Orleans, was not a randomized trial and, therefore, should be replicated.

“This is an area of growing importance because it may allow us to extend the indication for this effective treatment,” the lead author of the study, Dr. Dulka Manawadu, of King’s College Hospital in London, said in a news release. “The time is ripe to investigate effective treatments in this group of patients.”

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