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Strokes can be classified into 2 main categories:
- Ischemic strokes. These are strokes caused by blockage of an artery (or, in rare instances, a vein). About 87% of all strokes are ischemic.
- Hemorrhagic stroke. These are strokes caused by bleeding. About 13% of all strokes are hemorrhagic.
Most strokes (87%) are ischemic strokes. An ischemic stroke happens when blood flow through the artery that supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
An IV injection of recombinant tissue plasminogen activator (tPA) — also called alteplase (Activase) — is the gold standard treatment for ischemic stroke. An injection of tPA is usually given through a vein in the arm with the first three hours. Sometimes, tPA can be given up to 4.5 hours after stroke symptoms started.
The timing of treatment is important, because giving a strong blood thinner like tPA during a stroke can cause bleeding inside the brain. The longer a patient waits to get treatment, the more likely it is that the risks of treatment will outweigh the benefits.
This medication can help reopen blocked arteries in some people with ischemic stroke. It must be given as soon as possible, within 4½ hours after stroke symptoms started. tPA can reduce the severity of the stroke and reverse some stroke effects.
Although beneficial within 4.5 hours of stroke onset, administering recombinant tissue plasminogen activator (tPA) beyond that window appears to increase the risk of dying, a pooled analysis of eight clinical trials showed.
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Known by the generic name alteplase and marketed as Activase® (Genentech), tPA is given to patients through an IV in the arm, and it works by dissolving blood clots that block blood flow to the brain.
It has also been used in treatment for pulmonary embolism and myocardial infarction. TPA is a blood thinner, and therefore it is not used for hemorrhagic strokes or head trauma.
- Administer within 30 minutes of hospital arrival.
- Adults greater than or equal to 67 kg get 100 mg total dosage administered as a 15 mg IV bolus, followed by 50 mg IV infused over 30 minutes, and then 35 mg IV infused over the next 60 minutes.
Perspective. The findings confirm that tPA is highly effective when given within 3 hours of symptom onset. They also again suggest that tPA is effective to 4.5 hours after symptom onset, although the effects are not as robust as when it is given earlier.
The antidote for tPA in case of toxicity is aminocaproic acid.
First introduced in 1996, intravenous tPA can be administered to patients with ischemic strokes -- those caused by blockage of blood supply -- if treatment can be started within a few hours of the onset of symptoms.
The risk of hemorrhage is increased because tPA triggers plasmin activation, which degrades cross-linked fibrin into fibrin split products and reversal agents. Reperfusion injury and breakdown of the blood-brain barrier may also contribute to the risk of symptomatic intracranial hemorrhage.
Longer-lasting effects of the stroke may include problems with: Left-sided weakness and/or sensory problems. Speaking and swallowing. Vision, like the inability for the brain to take in information from the left visual field.
The medication, called tPA, or tissue plasminogen activator, can dissolve the blood clots that cause most strokes, often sparing patients from devastating brain damage. The drug increases the chance that a stroke patient will be able to regain normal functions and return home by about 30%, Adeoye says.
Cocaine, methamphetamines, and other stimulants can cause stroke in two ways. To begin with, stimulant drugs increase blood pressure. These drugs also have a direct effect on the vessel walls, and the extra pressure can cause them to rupture and leak blood into the brain. This is known as a hemorrhagic stroke.
The most commonly used clot-busting drugs -- also known as thrombolytic agents -- include:
- Eminase (anistreplase)
- Retavase (reteplase)
- Streptase (streptokinase, kabikinase)
- t-PA (class of drugs that includes Activase)
- TNKase (tenecteplase)
- Abbokinase, Kinlytic (rokinase)
