Last week a friend of the family suffered an ischemic stroke while talking to her children.  She developed difficulty speaking, had a right facial droop and right arm weakness.  She was taken to the local acute care hospital, had imaging studies to check for bleeding in the brain and, after a few days, was discharged home.  As I was told about her situation, a media story was released concerning recommendations about acute stroke management.  It related a series of articles from the Journal of the American Medical Association, discussing early management of stroke and the impact on decreasing disability.

Researchers noted that the majority of older patients who were surveyed wanted early thrombolysis in the case of a stroke, and this decision could lead to better functional recovery and less long-term disability if administered appropriately.  While the use of tissue plasminogen activator, or tPA, is not a new idea, the finding that most older patients would consent to such a procedure if asked was an important new finding.

Another important study released in the recent JAMA article showed that thrombolysis given in a specialized ambulance setting (stroke emergency vehicle) in Germany soon after acute ischemic stroke onset also led to treatment being given 15 minutes earlier without any increase in adverse events.

Lastly, a national quality initiative from 2010 to 2013 showed that in more than 43,000 patients treated in more than 1,000 participating hospitals, the “Door to Needle” administration times of less than 60 minutes for tPA in ischemic stroke led to lower in-hospital mortality and greater discharge to home.  Read the AHA journal article here.

In 2013, nearly 800,000 Americans suffered a stroke.  There clearly is a best practice for those who suffer ischemic strokes, and early, faster intervention is helping patients survive and recover with less long-term deficits.


Stuart J. Glassman, MD

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