Few Stroke Patients Given Clot-Buster Quickly Enough: Study

Few eligible stroke patients get an injectable clot-busting drug within the recommended 60-minute window after their hospital arrival, new research finds. "It has been widely recommended that the 'door-to-needle' time should be 60 minutes," said study author Dr. Gregg C. Fonarow, a professor of cardiovascular medicine at the University of California Los Angeles David Geffen School of Medicine. The phrase refers to the timeframe between when the patient arrives at the hospital and when that patient is given the clot-buster, known as tissue plasminogen activator (tPA).

In his analysis of stroke patients from 1,083 hospitals, he found the 60-minute window was not the typical reality. "That occurs only in 26.6 percent of patients," he said. Fonarow was slated to present the findings Thursday at the American Stroke Association's International Stroke Conference in Los Angeles; the research is being published simultaneously in the journal Circulation. Perhaps even more surprising, the hospitals in the study were all participating in the American Heart Association/American Stroke Association's Get with The Guidelines-Stroke quality improvement program, which recommends early tPA administration.

"It involved some of the largest, best-known hospitals for stroke care," Fonarow said. The study looked at more than 25,500 patients who had suffered ischemic stroke in which a blood clot obstructs blood flow and had been treated with tPA within three hours of the start of symptoms. Just 6,790 got the intravenous drug within 60 minutes. During the course of the study, there was only modest improvement in the hospitals' track records.

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Stroke Hospitalizations Up in Teens, Young Adults

Older Americans are suffering fewer strokes, but new government research shows that stroke hospitalizations are sharply rising among children and younger adults, especially for men under 35. Although the study doesn't explore the reasons for the trend, experts point to the obesity epidemic, increasing rates of diabetes and high blood pressure as likely culprits. Recreational drugs may play a role as well, they added. "Young people should see their doctor for regular checkups," said Dr. Brett Kissela, a professor of neurology at the University of Cincinnati Neuroscience Institute, who has conducted previous research on strokes but was not involved with this study.

Routine check-ups can help control risk factors for stroke, such as high blood pressure, he explained. Dr. Mary George, a researcher with the U.S. Centers for Disease Control and Prevention, is scheduled to report the findings Wednesday at the International Stroke Conference in Los Angeles. Experts note that research presented at meetings typically has not been subjected to the same scrutiny as studies published in peer-reviewed medical journals. For the study, CDC researchers examined hospitalization data for the period from 1994 to 2007 from the Nationwide Inpatient Sample, identifying patients with a primary diagnosis of ischemic stroke.

Ischemic stroke, which occurs when a blood clot or clogged artery blocks the blood supply to the brain, is more common than hemorrhagic stroke, the result of a ruptured blood vessel. The increases and decreases in stroke rates varied by gender and age group, the researchers found. Among males aged 15 to 34, the rate surged by nearly 53 percent. Among females in that age group, it increased 17 percent. Strokes soared 36 percent in boys aged 5 to 14 and 31 percent in girls of the same age. Men between 35 and 44 years old had a 47 percent increase in stroke incidence. For women in that age range, stroke incidence rose 36 percent.

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