Recombinant Tissue Plasminogen Activator and Stroke Treatment

Recombinant tissue plasminogen activator (tPA) is a medicine that can dissolve blood clots. Blood clots can block blood flow to the brain, causing stroke symptoms. Recombinant tPA is typically given through a vein. Patients may be given recombinant tPA if they have a stroke caused by clots (ischemic stroke). Recombinant tPA is not given to patients less than 18 years of age or for stroke due to bleeding (hemorrhagic stroke). Recombinant tPA can help a stroke victim if given early and under the right conditions. Many patients are not candidates for recombinant tPA for a variety of reasons. Recombinant tPA may be too risky to give depending on the onset, duration, or severity of stroke symptoms, and the presence of other medical conditions. Recombinant tPA does not lessen the chances of a stroke happening in the future. Recombinant tPA treatment itself involves some risks. Deciding whether to give recombinant tPA for a stroke is a critical and often difficult decision. Your caregivers and stroke specialists, along with you and your family members, must weigh the risks and benefits of this powerful treatment.

LET YOUR CAREGIVER KNOW ABOUT:

  • History of easy bleeding or blood problems, such as hemophilia or low blood platelets.

  • History of blood clots (thrombophlebitis).

  • Previous surgery, mainly any surgery in the past 14 days.

  • Recent spinal or brain surgery.

  • Broken bones or other injuries in the past 14 days.

  • Stroke within the last 3 months.

  • Past history of a hemorrhagic stroke.

  • Head injury in the last 3 months.

  • High blood pressure.

  • Blood in the urine (hematuria) in the last 21 days.

  • Brain tumors.

  • Allergies.

  • Recent heart attack.

  • Problems with diabetes.

  • Abnormality (such as aneurysms or malformations) of the blood vessels inside the head.

  • Possibility of pregnancy, if this applies.

  • Any other serious medical condition.

RISKS AND COMPLICATIONS

  • Bleeding into the brain. This occurs about 5% of the time, even when recombinant tPA is given under ideal circumstances. It can be quite serious.

  • Bleeding in other parts of the body.

BEFORE THE PROCEDURE

Recombinant tPA is one of many possible therapies that may be used to treat a stroke. Your caregivers must quickly determine, through a series of questions, whether or not you are a good candidate for recombinant tPA therapy. It is very important to answer these questions as accurately as possible. Steps before giving recombinant tPA may include:

  • A detailed history and exam by your caregiver. It is very important to determine when your stroke symptoms started. This will help your caregiver decide if recombinant tPA might help you.

  • Many readings of your blood pressure, pulse, and breathing rate (vital signs).

  • A CT scan (computed tomography) of your head. This is done to make sure there is no bleeding before recombinant tPA is given.

  • Stopping certain medicines such as blood thinners.

  • Giving medicines to adjust blood pressure if needed.

  • Drawing blood for several tests.

Your caregiver will review the results of the tests. He or she will explain the risks and benefits of this stroke treatment procedure.

PROCEDURE

Recombinant tPA can improve stroke outcomes if given within a set timeframe (currently 3 to 4 ½ hours, depending on your age) after the symptoms begin. If you and your caregiver decide to go ahead with the stroke treatment procedure, the following often happens:

  • Recombinant tPA is typically given through a vein. In some cases, recombinant tPA may be given directly into the affected artery through a catheter inserted through the groin.

  • If needed, medicines are given to help control blood pressure.

  • Frequent measures of vital signs are taken.

  • Frequent exams of your brain function are performed.

  • If bleeding occurs from recombinant tPA, the infusion will be stopped and appropriate therapy will be started.

AFTER THE PROCEDURE

  • You will be observed very closely, usually in the intensive care unit (ICU) or the stroke unit.

  • You may need to stop other medicines that affect how your blood clots 24 hours after getting recombinant tPA.

  • A CT scan of the head may be done 24 hours after the procedure.

  • Your brain functions will be checked very closely during your stay in the hospital.

  • It may take several days, weeks, or even months to fully determine how you responded to the recombinant tPA treatment. This is the case with any type of stroke therapy.