Clot-Busting Drug Access Increases Dramatically When Rushed Directly To Stroke Centres

Routing stroke patients directly to designated stroke centres - instead of taking them to the nearest hospital - dramatically increased access to a key clot-busting drug that can reduce stroke disability if given within the first few hours of symptoms, say Sunnybrook researchers.

During the study of a citywide initiative in Toronto, four times as many stroke patients were able to be treated with tissue plasminogen activator (tPA), a drug that dissolves clots, than had been treated prior to the start of the initiative.

Researchers examined the impact at Sunnybrook, one of three Regional Stroke Centres in Toronto.

As part of the Toronto protocol, paramedics were trained to screen for stroke and then transport stroke patients directly to a designated Regional Stroke Centre with an around-the-clock stroke team that could rapidly assess patients and administer tPA intravenously (also called thrombolytic therapy).

"Protocols like this are necessary because thrombolytic therapy has not been available at most hospitals, and too many patients arrive at hospital too late to receive treatment," said David Gladstone, lead author of the study and Director of the Regional Stroke Prevention Clinic at Sunnybrook Health Sciences Centre and Assistant Professor of Medicine at the University of Toronto. "Effective delivery of tPA for stroke requires an emergency response and a coordinated team approach involving paramedics, hospital stroke teams, emergency room and radiology personnel, and inpatient medical and intensive care staff.

"Time is brain," he said. "The faster the treatment is given, the greater the chance of a good outcome. Every minute counts during an acute stroke."

In the study, researchers examined the impact at Sunnybrook Health Sciences Centre, one of three Regional Stroke Centres in Toronto, during the first four months of the protocol activation and compared it to the same four-month period the previous year.

"It's all about getting the right patient to the right hospital at the right time," says Dr. David Gladstone, lead author of the study and Director of the Regional Stroke Prevention Clinic at Sunnybrook. "One of the most gratifying experiences in medical practice is to witness the dramatic recovery of a patient from a severe, disabling stroke after successful t reatment with tPA. For some patients, it is truly miraculous."

The study was supported by Sunnybrook Health Sciences Centre, University of Toronto Department of Medicine, Sunnybrook Osler Centre for Prehospital Care, the Registry of the Canadian Stroke Network and the Institute for Clinical Evaluative Sciences.