Healthcare practitioners should consider using intravenous tissue plasminogen activator in patients with mild stroke, as they already do in those with severe stroke, according to researchers.
Presenting findings last week at the American Stroke Associations International Conference 2011, the researchers said using tPA in patients with mild stroke could reduce the number of patients left disabled and save $200 million a year in disability costs.
Currently there is no standard of treatment for patients with the mildest strokes, even if they come into the emergency department quickly enough for intravenous tPA, said lead researcher Pooja Khatri, MD, associate professor in the Department of Neurology and director of acute stroke at the University of Cincinnati Academic Health Center in Ohio.
Khatri noted that the randomized trials proving tPAs efficacy excluded mild stroke patients. The thinking was that tPA treatment, which includes a slight but significant risk of life-threatening bleeding in the brain, would not be worth the benefit.
To assess the potential benefits of treating mild stroke patients with tPA, Khatri and colleagues examined hospital records of 437 patients diagnosed with mild ischemic stroke at 16 facilities in the Greater Cincinnati/Northern Kentucky region in 2005. The patients arrived at the hospital within 3.5 hours, inside the 4.5-hour recommended window for treatment with tPA.
Only four of the 437 patients received tPA. The researchers identified 150 of the remaining patients as likely candidates for the drug when disregarding the degree of stroke severity.
Excluding 37% of patients because of baseline disability, researchers figured that 8% to 13% of the remaining patients would regain independence after their stroke assuming tPA worked as effectively as it did in more serious cases.
Applying those percentages to the U.S. population, the researchers said tPA could save 2,176 to 3,761 patients per year from disability due to mild stroke if it proves effective. The estimated cost savings would be $200 million.
Based on previous studies, about a third of patients who experienced mild strokes remain disabled three months after initial hospitalization.