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January 6, 2000
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American Heart Association journal report:
Clot-buster therapy for stroke successful in rural hospitals
DALLAS, Jan. 7 -- By getting support from regional medical centers, smaller hospitals located in rural areas can effectively treat stroke patients with clot-busting medication, according to a study in this month's Stroke: Journal of the American Heart Association.
Researchers found that clot-busting medication called TPA (tissue plasminogen activator) was given safely and resulted in good outcomes for patients at community and rural hospitals that created and followed a stroke care protocol. According to researchers, lack of a stroke treatment protocol is one major reason the clot-buster is not given more often in small hospitals.
TPA is the only FDA-approved treatment for acute stroke. TPA must be given within three hours of stroke onset to be effective. TPA is used in patients with ischemic stroke, which is caused by a clot blocking blood flow to the brain. About 80 percent of all strokes are caused by blood clots.
"This study demonstrated that TPA can be safely given to acute stroke patients in rural and community hospitals with or without an on-site neurologist," says the study's lead author, David Z. Wang, D.O., director of the OSF (Sisters of the Third Order of St. Francis) Stroke Network in Peoria, Ill. "By following the protocol, even small hospitals can deliver good care to stroke patients."
Because of the lack of available neurologists in a particular area, rural hospitals sometimes have to rely on phone contact or other means by which to consult with an off-site neurologist. The neurologist can give the authorization for TPA to be given by emergency physicians or, in some cases, primary care physicians.
Between June 1996 and December 1998, about 900 ischemic stroke patients were treated at the OSF St. Francis Medical Center. Of those patients, 57 (6.3 percent) were treated with TPA. By comparison, the national average of patients receiving TPA is between 1 and 6 percent. In 35 percent of the patients, TPA was given by an emergency room or primary care physician in consultation with a neurologist who was not on-site.
Upon leaving the hospital, 47 percent of patients had minimal or no disability. Of the 57 who received TPA, 54 percent went home, 25 percent were transferred to in-patient rehabilitation and 12 percent were transferred to a nursing or skilled-care facility. Nine percent died from complications from their stroke.
Co-authors are Jean A. Rose, M.S.; Debra S. Honings, R.N.; Dennis J. Garwacki, M.D.; and Joseph C. Milbrandt, Ph.D.
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NR 00-1101 (Stroke/Wang)
Media Advisory: Dr. Wang can be reached by phone at (309) 655-2363, by e-mail at [email protected], by pager at (800) 231-7257 or by fax at (309) 624-8733. (Please do not publish numbers.)
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