Stroke Patients - Stabilisation

Stroke patients should be treated within three hours of the onset of symptoms to promote the best chance for a good outcome. The key point is ‘time is brain’.

Hospitals should have emergency stroke protocols so stroke patients can be assessed and treated within 60 minutes of arrival in an emergency treatment center. Nurses and a physician must see the patient promptly after his or her arrival. 

Not all strokes are treated the same, so determining the specific cause allows the stroke team to optimize treatment and help to prevent complications. Other ancillary staff, such as laboratory and EKG technicians, should also see the stroke patient.  Neurologists are available to see patients with stroke symptoms and arrange for admission to the hospital.

Thorough physical examination of the stroke patient is done. The doctor should check pulse and blood pressure, and examine the rest of the body (heart, lungs, etc). The neurological examination includes detailed tests of muscles and nerves. The doctor should also check strength, sensation, coordination and reflexes. In addition, questions should be asked to check memory, speech and thinking of the patient. 

The diagnostic modalities include sophisticated CT scans that view the stroke within the brain; MRIs that show which parts of the brain are permanently damaged and which can be repaired; and blood flow tests to show how much blood is getting to the brain.

Stroke patients should receive early and carefully chosen treatments for abnormal blood pressure, fever or abnormal blood sugar levels, which can negatively affect stroke outcome.

A tremendous amount of research is currently underway to find effective new drugs that can be helpful in minimizing stroke damage. Many of these new drugs are showing promise, not only for the emergency treatment of stroke, but also for stroke prevention.

Drugs for emergency stroke treatment

Among all treatments available to combat stroke, the most revolutionary stroke medication is thrombolytic therapy with the drug tPA (tissue plasminogen activator), the only FDA-approved drug for treatment of stroke. It is a clot-buster. It can literally stop an ischemic stroke as it is happening by breaking up the blockage and restoring blood flow to the brain.

Stroke patients who present to the hospital within three hours of the first sign of a stroke have the possibility to receive tPA. It even has the potential to significantly minimize and even reverse the effects of stroke if administered intravenously within the first three hours of the onset of symptoms.

The American Stroke Association reports that less than five percent of people who might benefit from tPA reach the hospital in time to receive it, largely due to lack of knowledge about stroke symptoms and the necessity of urgent treatment.

Ischemic stroke patients who have missed the three-hour window for intravenous tPA may have a chance of getting benefited from the drug due to a new technology i.e. intra-arterial administration of tPA that allows doctors to work inside blood vessels in minute detail.

The clot-busting tPA is injected near or directly into the clot to stop the stroke. This advanced procedure, known as intra-arterial thrombolysis, allows much less of the drug to be used and directs it to the exact site of the problem, yielding many positive results for the patient. This form of tPA must be given within six hours of the brain attack’s onset.

For those suffering hemorrhagic strokes, the same technique can be used to deposit tiny blocking agents, such as plastic balloons, or steel or platinum coils to stop the bleeding in the brain.

Drugs for stroke prevention

A number of medications that can help prevent stroke in high-risk patients, particularly those who have had previous transient ischemic attacks (TIAs) or minor strokes, are currently under investigation.

These drugs fall into two main categories:

Anticoagulants

Examples of anticoagulants are as heparin, Coumadin, warfarin, ximelagatran and Exanta. These may be given orally, intravenously or subcutaneously.

These stroke medications are commonly used to prevent the blood from forming dangerous clots that could result in a stroke. Often called "blood thinners," anticoagulants are often the first medication prescribed by doctors following a stroke.

By reducing the ability of the blood to clot and thereby reducing the likelihood of coronary or vascular emboli, anticoagulants are frequently used in patients that are already at high-risk for stroke. These stroke medications are very effective in helping to prevent stroke in patients with atrial fibrillation, or an abnormal beating of the upper chambers of the heart.

Antiplatelet agents

Examples of antiplatelet agents are aspirin, Persantine, dipyridamole, Plavix and clopidogrel.

These drugs work by preventing or reducing a phenomenon known as “platelet aggregation” in the bloodstream. When a blood vessel is damaged or injured, platelets migrate to the scene to initiate a healing process. Large numbers of platelets clump together to form a plug. This clumping can sometimes result in the formation of a blood clot that may totally block the artery or break loose and block a smaller artery.

By preventing this from occurring, antiplatelet agents can reduce the risk of stroke in patients who have had TIAs or prior ischemic strokes.

Stroke Drug Summary

Drug Name	Other Names	Used For	Drug Type
Aspirin	Acetylsalicylic acid, ASA	Stroke prevention	Antiplatelet
Clopidogrel	Plavix®	Stroke prevention	Antiplatelet
Dipyridamole	Aggrenox®, Persantine®, others	Stroke prevention	Antiplatelet
Heparin	Calciparine®, Liquaemin®	Stroke prevention	Anticoagulant
Ticlopidin	Ticlid®	Stroke prevention	Antiplatelet
Tissue Plasminogen Activator	tPA, Activase®	Acute stroke treatement	Thombolytic
Warfarin	Coumadin®, others	Stroke prevention	Anticoagulant