Stroke Severity as Well as Time Should Determine Stroke Patient Triage

STROKEAHA: January 3, 2013

The National Institute of Neurological Disorders and Stroke studies,1 published in 1995, demonstrated for the first time that in patients selected by clinical and noncontrast computed tomography criteria, intravenous TPA (IV tissue plasminogen activator) resulted in improved outcomes compared with standard treatment. Since that time, safe and quick delivery of IV TPA has become the primary focus of acute stroke management and forever changed the way that acute stroke care is delivered.

The most important variable that predicts response to treatment is time from symptom onset to treatment initiation.2,3 On the basis of European Cooperative Acute Stroke Study III (ECASS III),4treatment with IV TPA in Europe is approved out to 4.5 hours, but the benefit of treatment if started >3 hours is marginal if any. IV TPA is not approved >3 hours in the United States and best results occur if treatment is started within 2 hours.  Read more