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Clot-Busting Medication Appears Safe for ‘Wake-Up’ Stroke Patients

HOUSTON – The dilemma in treating patients who present with “wake-up stroke” is that emergency physicians have no way to determine if the stroke symptoms began less than 4.5 hours before, which is optimal for treatment with clot-busting medication.

A new study published in the Annals of Neurology, however, finds that using tissue plasminogen activator (tPA) is safe in those cases and calls for further studies to find out how effective it might be in a population of patients with few other treatment options.

The research, led by a team at The University of Texas Health Science Center at Houston (UTHealth), is touted as the first prospective multicenter study for people with "wake-up stroke.”

"Similar to heart attack, a significant portion — 1 out of 4 — of strokes start suddenly at or just before waking. At that time, the body undergoes many changes to prepare itself for wakefulness, including elevating the blood pressure by releasing stress hormones," explained co-principal investigator Andrew Barreto, MD. "Unfortunately, there are currently no treatments available for stroke patients who wake up with their stroke symptoms. Without tPA or some other form of restoring blood flow, the majority of these patients will be left with disabling effects."

For the study, 40 patients, aged 18 to 80 years, were enrolled at five stroke centers between October 2010 and October 2013. They were selected based on the appearance of non-contrast computed tomography, i.e., more than one-third middle cerebral artery territory hypodensity.

Standard-dose (0.9 mg/kg) intravenous rtPA was started within three hours or less of patient awakening.

No patients had intracerebral hemorrhaging according to study authors, who report that, at the three-month follow-up mark, 53% achieved excellent recovery according to the modified Rankin Scale.

"We plan to next move forward with a larger, randomized trial to definitively answer whether tPA reduces disability in this important group of stroke victims," Barreto added.