troke patients receiving clot-busting medications
before arriving at the hospital have a lower risk
for disability afterward, according to research
presented at the American Stroke Association’s
International Stroke Conference 2017.
Researchers analyzed results from 658 stroke patients who
were treated with tPA — a drug that dissolves blood clots.
About half of the participants received the clot-busting drug at
the hospital, and half received it while still in the ambulance.
This preliminary study showed that three months after
stroke, 182 out of every 1,000 patients treated before
arriving at hospital were less disabled, including 58 patients
who had zero disability, compared to people who received
treatment after reaching the hospital.
“Time is brain in acute stroke after vascular collaterals
fail, and faster treatment yields better outcomes,” said May
Nour, M.D., Ph.D., lead researcher, interventional neurologist
and director of UCLA’s Mobile Stroke Rescue Program. “Our
study shows pre-hospital clot-busting is a promising, evolving
approach to providing tPA stroke therapy. Its better outcomes
Past research showed that the sooner tPA is given after
an ischemic stroke — one in which a clot is blocking blood
flow — the better patients fare. But tPA is not indicated
and could hurt a patient’s chances if they are having a
hemorrhagic stroke, in which a blood vessel ruptures. That
is why patients need a CT scan to confirm the type of
stroke before receiving tPA.
Every second counts; in the current standard of care,
patients who experience stroke-like symptoms and call 911
arriving to the hospital by ambulance are assessed by clinical
examination and imaging (CT or MRI scan) in the Emergency
Department. This takes a certain amount of time from the
patient’s symptom onset which prompted the 911 call.
In a mobile stroke unit, a specialized ambulance is
equipped with a CT scanner, a paramedic, a critical care
nurse, a CT technologist and a neurologist in person or by
telemedicine. The ambulance arrives, does the CT on-site,
gives the clot-busting drug if indicated and then transports
the patient to the hospital.
Nour’s team used data from Berlin’s PHANTOM-S study,
which took place from 2011 to 2015 and included 427
participants (median age 72) that were compared to 505
patients who received conventional care with in-hospital clot
busting. Researchers analyzed information about patients’
disabilities to determine how many needed to be treated in
the mobile stroke unit to yield a greater benefit in disability
outcomes when compared to patients who received tPA at
The findings bordered on statistical significance,
suggesting that future clinical trials with a greater number of
patients are needed to show similar benefits.
“People should know the warning signs of stroke and
call 911 as soon as they observe stroke signs,” said Nour.
“Treatment then needs to happen as quickly as possible,
and a mobile stroke unit may allow that to happen.”
Receiving a clot-buster drug
before reaching the hospital
may reduce stroke disability
By American Heart Association News