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TPA: The “Clot-Buster” Drug
05/12/2014

By now, you’ve probably heard that “time is brain” when it comes to stroke care. While it’s a simple, useful reminder to get your loved ones to the hospital as quickly as possible if they are experiencing stroke symptoms, it’s not the only reason time is a huge factor. Yes, the longer you wait to come to the hospital, the higher the risk is for long-term disability and brain damage, but there’s a good reason for that. The most important treatment for stroke has a window of time in which it can be used, meaning that, for someone experiencing a stroke, it’s a race against the clock to make sure that treatment is received in time.

That treatment is TPA, or tissue plasminogen activator. It also is known as the “clot-buster,” a name that reflects its ability to break up the blood clot that is causing the stroke. “We have all sorts of different blood thinners, anticoagulants, and medicines such as aspirin and Plavix that help prevent stroke because they keep us from clotting as quickly,” said Blount Memorial hospitalist and stroke medical director Dr. Deaver Shattuck. “Once you have a clot, though, those treatments are not going to do any good. You have to bust that clot up, and that’s what TPA does,” he explained.

Shattuck says, if you’re having a stroke, you have approximately 4.5 hours before the window to use it closes. “The reason it’s important to give this medicine very, very early is because if you wait later than that, there’s an increased risk that the stroke has damaged the blood vessel where the clot is located. If TPA gets used where there is a damaged blood vessel, say five or six hours after that clot first formed, you have an increasing risk of bleeding into the brain itself. That’s the danger of that drug,” he explained. “If you bleed into your brain, that’s a catastrophic complication and something we definitely want to avoid,” he explained. “The earlier you give the medicine, the more brain you save. It’s more effective and much, much safer the earlier you can give it. Our goal for giving TPA at Blount Memorial is within an hour of the onset of symptoms. The quickest one we’ve ever done was in 33 minutes. That’s very, very fast and we’re really proud of that, but we want to do that time on every patient we can because it’s more effective,” he added.

Which is why for stroke care, Shattuck says you should absolutely try as hard as you can to come in at the first signs of a stroke. “It’s devastating, both for a physician and a family, when you see someone come in who has had a stroke and has missed that window. Those people likely will have lifelong disabilities that will require lots of extra care. If you had had the chance to give them the medicine they needed early on, you could have prevented this lifelong disability. We won’t be satisfied until we’re at 100 percent of everyone who could possibly get TPA for stroke is inside the window to get it,” he added.

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