The global burden of stroke is immense and growing, a new report suggests, making it one of the biggest public-health problems worldwide in terms of both death and disability. Experts have called for a three-pronged approach encompassing prevention, acute treatment and recovery/rehabilitation to stem the tide. Yet despite billions of dollars invested in research over the last few decades, little progress has been made in preventing or treating stroke. Perhaps nowhere is this failure clearer than in the emergent treatment of stroke.
The clot-busting drug known as tPA (tissue plasminogen factor) was approved in the U.S. in 1996, and remains the only treatment for acute ischemic stroke (strokes caused by a blood clot or narrowing of a blood vessel–see image). tPA has been shown to be highly effective in sparing brain damage and reducing disability when used appropriately in the right group of patients, but the drug is widely underused.
That situation is slowly improving–a study published in 2013 found nearly twice as many stroke patients received tPA in 2011 than in 2003. Still, only about 7 percent of stroke patients receive the drug. A growing chorus of experts are saying that’s because of outdated guidelines that are too restrictive in delineating which patients are eligible for tPA therapy.