Now, keep up to date
with daily feeds of newly posted stories
about America's Seniors...click on the box
to the left
Clot-Buster boosts survival, decreases
disability for deadly subset of Stroke
Newswise — New results from a multicenter
study led by Johns Hopkins show that
patients who got an experimental
clot-busting treatment for a particularly
lethal form of stroke were not only
dramatically more likely to survive but also
continued to shed lingering disabilities six
months later.
The findings, announced at the International
Stroke Conference in San Diego on Feb. 19,
are likely to build support for the use of
tissue plasminogen activator (tPA) in
patients with intracranial hemorrhage, a
treatment-resistant form of stroke marked by
brain bleeding.
Last May, study leader Daniel Hanley, M.D.,
professor of neurology at the Johns Hopkins
School of Medicine, and his colleagues
reported early findings among 52
intracranial hemorrhage (ICH) patients
treated with tPA given by catheter directly
into patients’ brains to bathe and destroy
blood clots with this clot-busting agent.
The researchers worked with patients at 38
study sites scattered throughout the United
States, as well as Canada, Germany and
Finland.
The treatment, developed by Hanley’s team,
gives low doses of tPA over several days
after strokes involving intracranial
hemorrhage.
This drug normally isn't recommended for
conditions that involve bleeding, such as
ICH, because it can increase the risk of
further hemorrhage.
However, since tPA is effective at breaking
up clots in other conditions, such as heart
attacks and other types of strokes, Hanley
and his colleagues have been studying its
safety and efficacy for treating ICH.
Early results from this study using
information collected 30 days after tPA
treatment showed that about 80 percent
survived, compared to data from previous
studies showing that about 80 percent of
untreated ICH patients die.
In the new study, the researchers report on
the patients’ progress six months after
treatment using assessments for overall
levels of disability as well as their skill
in accomplishing specific tasks often
affected by stroke, such as dressing,
bathing or walking.
The researchers found that about 10 percent
of patients had no lingering disability
after six months.
Another 40 percent had only mild to moderate
disability and were independently caring for
themselves at home by 180 days, but required
assistance with everyday tasks such as
lifting heavy objects.
Even patients who were initially more
severely disabled continued to improve
months after treatment, with the majority
scoring lower on disability assessments
after six months compared to the same
assessments taken at 30 days.
“We’re painting a pretty good picture for
quality of life after our treatment for ICH,”
Hanley says.
“Survival doesn’t have to mean just getting
by—we’re showing that it can mean truly
living again.”
Hanley adds that patients, families,
physicians and ethicists worry deeply about
the impact of stroke treatments that keep
patients alive but leave them with a sharply
curbed quality of life.
“Our new treatment appears to greatly
increase patients’ chances for survival and
quality of life similar to what they
experienced before they had their stroke,”
he says.
Intracerebral hemorrhage, or ICH, causes
blood to pool and clot inside the brain’s
interior cavities, building up pressure
within the brain.
The higher pressure, along with inflammation
caused by chemicals in the trapped blood,
can irreversibly damage the brain, usually
leading to death or extreme disability.
Hanley and colleagues, with a clinical
planning grant from the National Institute
of Neurological Diseases and Stroke will
design a pivotal test to assess the value of
tPA therapy on a much larger group of ICH
patients. They expect to start this clinical
trial imminently..
Other Johns Hopkins researchers who
participated in this study include Wendy
Ziai, M.D.; Ricardo Carhuapoma, M.D.; Neal
Naff, M.D.; Becky Sullivan, M.B.A.; Timothy
Morgan, B.S.; Eric Melnychuk, B.A., E.M.T.-B;
Susan Rice, R.N., M.P.H., C.C.R.P.; Amber
Stahl, B.A.; Shannon LeDroux, B.S.; Amanda
Bistran, B.S.; and Karen Lane, C.M.A.,
C.C.R.P
... ..
...
...