Not Enough Who Suffer Ischemic Stroke Get Clot-Busting Drug

David Langer, MD

Stroke remains one of the leading causes of death and disability in the United States. Unfortunately, the treatment of stroke remains problematic due to the difficulties involved in getting patients diagnosed and treated in a timely fashion. The clot-busting drug tPA remains the only Food and Drug Administration (FDA)-approved drug for acute ischemic stroke (AIS) which is caused by a blood clot in the brain. In order for tPA to be effective, it should be administered within the first three hours after the initial onset of stroke symptoms.

Recently, researchers from the University of Cincinnati reported in the American Heart Association’s Stroke journal that 3.4 percent to 5.2 percent of Americans who suffered from an ischemic stroke in 2009 received tPA compared to 1.8 percent to 2.1 percent in 2005. While this finding is a sign of improvement, it is still very low. As such, we must continue to improve our treatment of stroke patients. Time remains a critical element in stroke management.

Current efforts both in basic science, as well as in system-based work flows in stroke management, are ongoing in efforts to improve the outcome of stroke patients. The goal is to preserve the brain, while improving identification of stroke and treatment.

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Examining the "Stroke Belt"

Richard Libman, MD

National patterns of racial and regional differences in stroke incidence are similar to those for stroke mortality; however, the magnitude of these differences in incidence appears smaller, according to a study appearing in a recent issue of the Annals of Neurology. Known as REGARDS (the REasons for Geographic And Racial Differences in Stroke), the national study further elaborates on the geographic variation in the incidence of stroke, stroke risk factors and cognitive impairment, a condition that includes problems with memory, language or other mental functions.

It has been known for some time that the "stroke belt" is a geographical region with a significantly higher incidence of brain attacks. Stroke by itself is a major contributor to cognitive impairment and dementia. Furthermore, such risk factors for stroke as high blood pressure and diabetes are independent risk factors for cognitive impairment. In the REGARDS study, living in the stroke belt was also a risk factor for cognitive impairment.

The important message is that careful analysis of what makes the stroke belt different from other areas of the country can lead to more insight into what is causing the cognitive impairment, and, hopefully, result in effective preventive measures and treatment.

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