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Stroke Patients Benefit From Clot-Busting Drug

A drug that breaks up blood clots in the brains of stroke patients could be used more widely than at present without increased risk, a brain scan study suggests.

It had previously been thought that giving the drug to people with signs of early damage in the brain caused by a stroke would increase the chances of their suffering a bleed on the brain, which can be fatal.

The study is the first to show that early tissue damage seen in brain scans does not necessarily indicate an increased risk of bleeding. Patients with early tissue damage from strokes are less likely to make a full recovery, but they can benefit from receiving the drug, researchers say.

The drug, called alteplase, is the only treatment for a stroke caused by a blocked blood vessel in the brain.

Worries over the appearance of patients’ brain scans taken on arrival at hospitals to diagnose strokes have previously probably meant patients who could have benefited from alteplase did not receive it, the team says.

Experts were concerned that patients with early brain tissue damage that can be difficult for stroke specialists to see were more likely to suffer a brain bleed if they were treated with alteplase.

Researchers at the University of Edinburgh found there is an increased risk of hemorrhage only in patients with multiple signs of tissue damage caused by other diseases prior the stroke that are easily identified in scans, together with signs of a fresh clot blocking an artery.

In the small number of people with signs of both previous tissue damage and a new clot in a blood vessel, 14% of patients given alteplase are likely to experience a hemorrhage, the team says. However, in people without these signs, only 3% are expected to suffer a bleed if they are given the drug.

Researchers analyzed more than 3,000 people involved in a clinical trial assessing the effectiveness of alteplase as a stroke treatment.

Patient risk factors are easy to identify in brain scans, enabling physicians to decide whether the risk to patients outweighs the potential benefits of receiving alteplase, the team says.

The study was published in the journal The Lancet Neurology. Professor Joanna Wardlaw of the University of Edinburgh’s Centre for Clinical Brain Sciences, who led the study, says, “Bleeding in the brain is the main side effect of alteplase, so if we can avoid that hazard, then patients are more likely to benefit. Previous studies have not looked at preexisting signs of damage nor considered analyzing multiple signs in combination, yet having multiple and old signs are both very common in patients with stroke.”

— Source: The Lancet Neurology