Stroke: Save a minute, save almost two days
Stroke (2014) doi: 10.1161/STROKEAHA.113.002910
Rapidly restoring blood flow is crucial to ensure as many brain cells as possible survive after a stroke. However, intravenous tissue-type plasminogen activator (tPA) 'is the only medical therapy shown to improve patient outcomes in acute ischaemic stroke'. For example, compared to placebo, tPA thrombolysis increases a patient's chance of a disability-free recovery 2.6 fold when treatment starts within 1.5 hours of symptom onset. Starting tPA between 3 and 4.5 hours after symptoms emerge increases the chance of a disability-free recovery by 30%. Indeed, reducing the time between symptom onset and tPA by a minute may save two million neurones.
Now a new study that applied evidence from major tPA trials to 2258 stroke patients from Australia and Finland has reported that 'realistically achievable small reductions' in the time between the start of symptoms and tPA treatment can produce significant and robust improvements in outcomes. Overall, for example, a 15-minute decrease in onset-to-treatment time translated into, on average, an additional month of disability-free life. Each minute of onset-to-treatment time saved translated into, on average, an extra 1.8 days of healthy life.