Harvard Heart Letter

Heart Beat: Extending the time for stroke treatment

Heart Beat

Extending the time for stroke treatment

When a stroke strikes, minutes matter. The faster you recognize a stroke and get to the hospital, the faster treatment can begin. Time lost, as they say, is brain lost.

If the stroke is an ischemic stroke, caused by a blood clot blocking the brain, the preferred treatment is administration of a clot-busting drug called tissue plasminogen activator (tPA). But there's a hitch: tPA works best when given soon after symptoms start. For years that meant within three hours of the start of symptoms. Guidelines from the American Stroke Association say it's now okay to give the drug up to four-and-a-half hours after the onset of symptoms (Stroke, published online ahead of print).

Extending the treatment window doesn't mean it's okay to delay seeking help. The sooner tPA therapy is begun, the better the results. According to Dr. Jeffrey Saver, director of the UCLA Stroke Center and an author of the revised guidelines, starting tPA in the first hour of a stroke is better than starting it in the second or third hours.

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