NEW ORLEANS -- Researchers examining data on stroke patients in rural East Texas find that almost none of them are receiving clot-busting drugs that could reverse the effects of stroke.
The results of two studies were presented here today at the American Stroke Association¹s 25th International Stroke Conference. The American Stroke Association is a division of the American Heart Association.
In one study, researchers found that in a sampling of five hospitals, only three of 225 stroke patients (1.3 percent) received tissue plasminogen activator (TPA) for stroke. This was mainly because they arrived later than three hours after the onset of the stroke. Another reason for the low percentage was because of a lack of knowledge to call 911, according to a second study in the same area.
"We've been telling people for a long time about stroke symptoms, but that doesn't seem to be making an impact," says the study's lead author, Lewis Morgenstern, M.D., co-director, stroke program, University of Texas, Houston, Medical School. "We really have to motivate people to come to the front door of the hospital quickly. We have very effective treatments for stroke, but they must be given immediately after stroke symptoms begin. More needs to be done to educate the public and professionals."
A major reason people didn't receive the treatment is that they arrived at the hospital more than three hours after the onset of stroke. TPA must be administered within three hours to be effective. Nearly 40 percent of the patients (83 of 225) who would have been eligible for TPA did not receive it because they arrived too late. Another 53 percent did not receive the therapy because of medical reasons such as transient ischemic attack, or mini-stroke, bleeding in the brain, presence of a tumor or a head injury. Additionally, due to in-hospital delays, 20 of 225 stroke patients (8.9 percent) did not receive treatment.
The findings have led the researchers to consider other ways to educate people who live in rural communities.
In a related study examining whether people called 911 in response to stroke symptoms, only 35 percent used 911 out of 485 hospital visits relating to stroke and stroke-like symptoms.
"Educational efforts directed toward patients at high risk for stroke are insufficient," says one of the study's authors, Theodore H. Wein, M.D., cerebrovascular fellow, The University of Texas, Houston, Medical School. "Stroke patients may not be able to use the telephone, potentially leading to their low rates of contacting the emergency medical system."
In Wein's research, out of the group who did call 911, only 4.5 percent of stroke patients called 911 themselves. In 63 percent of cases, a family member or significant other called 911 when the stroke occurred.
"To improve the low percentage of patients transported by the emergency medical system, we should concentrate our educational efforts on family, caregivers and co-workers of people at high risk for stroke," says Wein.
Both studies are a part of the T.L.L. Temple Foundation Stroke Project, which is being undertaken by researchers at the University of Texas, Houston Health Sciences Center. The study centers on Angelina, Nacogdoches and Shelby counties in Texas. The combined population of the three counties is approximately 150,000.
Co-authors for the two studies are: Lara Staub; Susan Hickenbottom; Janet Groff; L.K. Bartholomew and Arada Kunyosying.
NR 00-1104 (StrokeConf/Morgenstern)
Media Advisory: Dr. Morgenstern can be reached by phone at (713) 500-7099, by fax at (713) 500-7019 or by e-mail at lmorgens@neuro.med.uth.tmc.edu. Dr. Wein can be reached by e-mail at twein@umich.edu. (Please do not publish numbers.)