Stroke Care: The TPA drug use debate

About 87 percent of all strokes are ischemic, meaning they’re caused by a blood clot in the brain. For over 20 years, the standard of care has been a drug called TPA. But now, some doctors are questioning whether TPA is the best bet for patients.

When it comes to a stroke, time is brain. TPA, the only clot-busting drug approved to help lessen the damage has to be given within three hours.

But, research shows not everyone who arrives to the hospital on time receives TPA. In fact, up to 30 percent of stroke patients who are good candidates for the drug don’t get it. The reason? Some doctors are skeptical, saying studies showing it worked were flawed and the drug poses a risk of bleeding.

George J. Shaw, MD, University of Cincinnati College of Medicine, says, “Even if it’s given properly, about six percent of people will have bleeding in the brain just from the TPA. I’ve seen that a couple of times. It’s never good. It’s always bad.”

Still, the American Heart Association and the American Stroke Association strongly endorse the use of TPA in appropriate patients, calling it the “gold standard.” The landmark research that first brought attention to TPA happened more than 20 years ago. And since then, other studies have shown its benefits in reducing disability after stroke.

“About 1/3 of folks, if you look at them six months after their stroke and if they’ve gotten it tend to do better neurologically than those who haven’t gotten TPA,” continued Dr. Shaw.
The bottom line? TPA might be the only treatment for stroke, but it’s not one without risk.
Some doctors who disagree that TPA is the best treatment believe it’s better to let a stroke just run its course. They’re calling on more studies to prove the benefits outweigh the risks when it comes to TPA.

Contributors to this news report include: Julie Marks, Producer; David Harrison, Editor.