Stroke Medications and Treatment
“Time is brain” is the repeated catch phrase when addressing the treatment and management of stroke (Saver, 2006). Access to prompt and appropriate medical care during the first few hours of stroke onset is critical to patient survival and outcomes. Recent changes in the guidelines for acute stroke care released by the American Heart Association (AHA) and the American Stroke Association (ASA) have improved patient access to treatment. Stroke treatment now follows the model of myocardial infarction treatment. Hospitals are categorized into four levels based on stroke treatment capability. The most specialized treatment is available in comprehensive stroke centers followed by primary stroke centers, acute stroke-ready hospitals, and community hospitals. The use of telemedicine now enables even community hospitals, with limited specialized capabilities, to care for stroke patients. Telemedicine puts emergency hospital personnel in contact with neurologists providing expertise in the evaluation of a stroke patient and determination of their eligibility for treatment with thrombolytic medication (Jefferey, 2013).
A recent study in the Journal of the American Medical Association stressed the importance of onset to treatment time as a factor in patient clinical outcomes. The study also indicated that early treatment of ischemic stroke with intravenous recombinant tissue plasminogen activator (rtPA) resulted in fewer deaths, intracranial hemorrhage, and an overall better prognosis for patients post-stroke (Saver et al., 2012).
The clot-dissolving drug, also known as alteplase, is the only FDA approved medication for acute ischemic stroke and is recommended to be administered intravenously within 3 hours of stroke onset (Jauch, Kissela, & Stettler, 2013; Jefferey, 2013). However, in 2007 AHA/ASA adopted into its guidelines the 2009 scientific advisory, which advocates the off-label use of rtPA beyond the 3-hour window to within 4.5 hours (del Zoppo et al., 2009). There are contraindications for the use of rtPA in the treatment of hemorrhagic stroke and in patients with previous stroke, recent surgery, acute myocardial infarction, trauma, pulmonary embolism, intracranial neoplasm, arteriovenous malformations or aneurysms, and uncontrolled hypertension (Lansberg et al., 2012).
In addition to intravenous (IV) administration, rtPA may also be delivered by an endovascular procedure called intra-arterial thrombolysis. Direct release of rtPA via a catheter threaded through the femoral artery into the stroke area may be performed beyond the 4.5-hour limit of IV rtPA, extending the window of treatment (Meyers et al., 2011).
Anti-platelet drugs such as aspirin and clopidogrel (Plavix), as well as, anticoagulant drugs such as warfarin (Coumadin) and dabigatran (Pradaxa) may be administered, alone or in combination, after an ischemic stroke to prevent the chance of another stroke (Jauch et al.,...