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Improving Outcomes for Stroke Patients

Posted on October 27, 2017

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Individuals who experience an ischemic stroke and do not receive an intravenous alteplase medication designed to dissolve blood clots face a higher risk of death, according to new research from Georgia State University.

Stroke is the third leading cause of death in the U.S., after coronary heart disease and cancer. Each year 600,000 Americans have a stroke, and 150,000 die as a result. Fifteen percent of people who suffer a stroke die within 30 days, and between 15 and 30 percent of stroke sufferers are left disabled.

Intravenous alteplase was approved by the Food and Drug Administration in 1996 as a treatment for ischemic stroke because of its ability to quickly restore blood flow to the brain. This reduces the risk of permanent side effects of stroke, like speech problems, cognitive difficulty and loss of mobility.

Despite its significant benefits, only a small percentage of people who experience an ischemic stroke receive the drug.

Researchers on the study reviewed data from the Georgia Coverdell Acute Stroke Registry collected between 2008 and 2013 and compared it to Georgia hospital discharge data from the same years and death data from 2008 to 2014.

In all, researchers examined information from 9,620 patients from 48 hospitals. Their research took into consideration ischemic stroke patients who could not receive intravenous alteplase because of pre-existing complications like a previous brain surgery.

Of the eligible patients, they found that only 25 percent received the drug.

They also found that 12 months after experiencing an ischemic stroke, individuals who did not receive intravenous alteplase had a 49 percent greater risk of dying than individuals who received the drug immediately after their ischemic stroke.

Study authors suggest that physicians are less likely to use the drug to treat a patient experiencing ischemic stroke because of its complications, which blurred vision, swelling of the extremities and excessive bleeding.

Despite its side effects, the GSA researchers believe that intravenous alteplase should be administered to ischemic stroke patients to reduce mortality risk and improve health outcomes.

“A stroke can do significant damage to the brain,” said Dr. Joel Singer, M.D.

Singer treats patients who are living with damage caused by ischemic stroke.

“When blood flow to the brain stops because of a blood clot, the brain immediately loses oxygen, and brain tissue begins to die. Depending on the site of the stroke, a range of results can occur, but commonly, motor and cognitive functions are impacted,” Singer said.

Although research has found that the brain adapts to its new post-stroke state by rewiring itself to work around damaged areas in a process known as neuroplasticity, brain cells that are damaged by a stroke cannot repair themselves.

That inability to repair means long-term damage.

“The damage of the stroke in combination with the fact that the brain does not heal itself means that people who suffer a stroke are left with a lifelong disability. In some cases, the level of disability can be severe and impact the patient’s quality of life,” Singer said.

Singer is changing outcomes for stroke patients using adipose fat stem cells taken directly from the patient and deploying them back into the patient.

“Stem cells know exactly where to go to repair tissue because the damaged cells of the brain are emitting messages, known as growth factors, sending out the call for help,” Singer said.

Once the adipose fat stem cells reach the brain, they go to work repairing the damage caused by the stroke, but without the risk of side effects.

“Since the stem cells come directly from the patient, there is no risk of rejection or adverse reaction. Patients see improvements in their condition, such as improved mobility and improved speech,” Singer said.

Like intravenous alteplase, there’s a critical time frame for using stem cell therapy for patients who have suffered a stroke.

“The ideal time for treatment is about 15 days after the stroke to maximize benefits,” Singer said.

Sources:

JAMA – Journal of the American Medical Association. “Earlier treatment with surgery to remove blood clot linked with less disability following stroke.” ScienceDaily. ScienceDaily, 27 September 2016.

Internet Stroke Center. Stroke Statistics. 2017.

 

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