Contacts: Sarah Goodwin Kathi Ovnic Holly Korschun

June 9, 1999

EARLY STROKE TREATMENT WITH t-PA HAS LONG-LASTING BENEFIT,ACCORDING TO NEJM REPORT One year after experiencing stroke, patients who received a clot-buster early on were significantly less likely to be disabled than patients who did not receive treatment, reports the National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator (rt-PA) Stroke Study Group in this week's issue of the New England Journal of Medicine. "These findings are particularly significant in light of the staggering toll stroke can take on those who survive it," says third author Michael Frankel, M.D., associate professor of neurology at the Emory University School of Medicine and chief of neurology at Grady Memorial Hospital. "Since stroke is the leading cause of adult disability in the United States, any means to reduce its disabling effects translates into enormous cost-savings and improvements in quality of life." Patients treated with tissue plasminogen activator (t-PA) within three hours of experiencing symptoms of acute ischemic stroke, "were at least 30 percent more likely to have minimal or no disability at 12 months than were the placebo-treated patients" the group reports. The current study extends to one year the group's 1995 findings of a sustained three-month benefit from early t-PA treatment. The study population was comprised of 624 ischemic stroke patients randomly assigned to receive either t-PA or placebo intravenously in the emergency department within three hours of stroke symptom onset. According to Dr. Frankel, 39 stroke patients at Grady and Emory Affiliated Hospitals were entered into the Emory component of the multicenter trial. "Other large studies of thrombolysis for the treatment of acute ischemic stroke have shown either no benefit or equivocal benefit from intravenous t-PA or streptokinase and high rates of early mortality and intracerebral hemorrhage," the group says. "Reasons for the disparity between the results of these studies and ours may include differences in the time from the onset of symptoms to the initiation of treatment (0 to 3 hours in our study as compared with 0 to 4 or 6 hours in other trials), the choice and dose of thrombolytic agent, and the concomitant use of heparin or aspirin. In addition, we used a strict algorithm for the management of blood pressure after beginning treatment with t-PA."In the current study, neither survival rates nor recurrent stroke rates differed significantly between the t-PA and placebo groups 12 months after stroke. Stroke ­ or brain attack ­ occurs when parts of the brain become starved for blood. Ischemic stroke, which comprises 85 percent of strokes, occurs when a blood vessel in the brain becomes blocked by atherosclerosis or a clot. Hemorrhagic stroke is caused by a ruptured blood vessel in the brain. According to the American Heart Association's 1998 Georgia Stroke Report, stroke symptoms include sudden weakness or numbness on one side of the body; sudden difficulty speaking; sudden dimness or loss of vision, particularly in one eye; unexplained dizziness, unsteadiness or sudden falls; or sudden, severe headaches with no known cause. The May 1999 issue of Georgia Epidemiology Report, states the following: -- Georgia's stroke death rate is the sixth highest in the country, and in 1996, Georgia's rate was 24 percent higher than the U.S. rate. -- Stroke is the third leading cause of death in Georgia, accounting for 4,276 deaths in 1997. -- In 1997, there were 24,553 hospitalizations for stroke among Georgians, or on average, a hospitalization for stroke every 21 minutes. -- Stroke is not just a disease of old age: One in five Georgians who died from stroke in 1997 was younger than 65 years of age.   ###