JAMA editorial calls for better use of new stroke drug

February 29, 2000
Web posted at: 4:00 p.m. EST (2100 GMT)

From staff reports

NEW YORK (CNN) -- A new medication available for emergency treatment of strokes must be better administered by doctors, or it will lack the effectiveness demonstrated in clinical trials, says an editorial in this week's Journal of the American Medical Association.

Public knowledge of stroke symptoms and getting victims to a hospital quickly are also needed for the new medication to work, writes Dr. J. P. Mohr of the Columbia-Presbyterian Medical Center Neurological Institute, New York.

After a landmark study showed that a drug called "tPA" was safe and effective, the U.S. Food and Drug Administration in 1996 approved the medication for stroke patients. But "tPA" -- which dissolves clots blocking normal blood flow -- must be used within three hours of the onset of symptoms.

"With every tick of the clock up to the three-hour limit, the chances for neurologic improvement fade and hemorrhagic complications increase," Mohr writes.

Two other reports in this issue of JAMA offer conflicting evidence of how effective the administration of "tPA" is in treating victims of stroke, particularly ischemic stroke where blood clots obstruct arterial blood supplying the brain.

The differences in the two studies reinforce the belief that physicians providing emergency treatment in a hospital are not as likely to follow complicated guidelines as are physicians engaged in formal clinical research attempting to measure drug effectiveness and safety, the reports indicated.

Rules governing the timing of treatment, use of blood thinners, control of blood pressure and other factors in administering "tPA" must be strictly adhered to if the success of the formal clinical trials are to be matched in community, university and urban hospitals, said Mohr.

Officials of The National Stroke Association strongly recommend seeking immediate medical attention if you have a sudden weakness or numbness of your face, arm or leg especially if it is on one side of your body, or if you experience rapidly occuring dizziness, loss of balance or coordination, particularly when combined slurred speech or double vision, numbness, or sudden, unexplainable intense headache.

Behind heart disease and cancer, stroke is the third leading cause of death among Americans. More than three times as many people die of stroke each year in the United States as in motor vehicle accidents.

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National Institute of Neurological Disorders and Stroke
The Internet Stroke Center

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