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University of Iowa News Release

Release: April 4, 2003

UI Neurology Professor Leads Update Of Urgent Stroke Care Guidelines

A neurologist at University of Iowa Hospitals and Clinics led the effort to update the guidelines for treating patients affected by ischemic strokes. The updated guidelines from the American Stroke Association are published in today's issue of Stroke: Journal of the American Heart Association.

The "Guidelines for the Early Management of Patients' Ischemic Stroke" is a revision of statements and supplements written in 1994 and 1996. The statement, aimed at primary care physicians, emergency medicine physicians, neurologists and others who provide acute stroke care upon hospital admission through the first 48 hours, discusses how to manage the neurological and medical problems that can complicate patient recovery.

Stroke is the third leading cause of death in the United States and the leading cause of disability. Ischemic strokes, the most common type of stroke, are caused by a blood clot blocking blood flow to the brain. Giving tissue plasminogen activator (tPA) within three hours of stroke onset is the only U.S. Food and Drug Administration-approved treatment for ischemic stroke.

"It was time to review the state of acute stroke care. Considerable research in stroke has been done in the last decade, and the guidelines for physicians need to reflect the new information," said Harold P. Adams, Jr., M.D., chair of the panel that authored the guidelines and professor of neurology in the UI Roy J. and Lucille A. Carver College of Medicine.

Some of the recent research has investigated neuroprotective agents to prevent stroke damage, methods to induce hypothermia to reduce fever and prevent stroke damage, other clot busting drugs and techniques, imaging techniques to diagnose ischemic stroke, and surgical interventions.

While the advances are considerable, noted Adams, "much additional work needs to be done. In this statement, we re-emphasize the potential use of rtPA for emergency intravenous management of carefully selected patients who could be treated within three hours of ischemic stroke."

Among their recommendations, the panel notes:
-- A regional or local organized program to expedite stroke care can increase the number of patients treated.
-- Because time is of the essence in acute stroke care, institutions should have diagnostic equipment and staff available 24 hours a day, seven days a week or consider transferring stroke patients to a better-equipped facility.
-- To date, no other clot-busting agent has been established as a safe and effective alternative to tPA.
-- Intra-arterial thrombolytic therapy, a catheter-based treatment that delivers a clot-dissolving drug to the precise location of the brain blockage up to six hours after symptom onset, holds promise for some strokes, but its effectiveness has not been established.
-- Anticoagulants, such as heparin, are not indicated for most ischemic stroke patients.

"In the previous guidelines, we concluded that the data were insufficient to make any recommendation about the use of anticoagulants," Adams said. "Since then, several trials have tested the potential use of anticoagulants for early treatment of patients with stroke - and with negative results."

Other recommendations:

-- Aspirin may be given within 48 hours of stroke onset for most patients, but not within 24 hours of treatment with rtPA. Aspirin has a modest benefit, but it should not be considered as an alternative to rtPA for treatment of acutely ill patients.
-- No medication with neuroprotective effects has been shown to be useful for ischemic stroke patients.
-- Stroke units, including comprehensive rehabilitation services, and specialized stroke treatment centers should be developed.
-- Steps should be taken to prevent additional strokes and rehabilitation plans are important part of acute care.

Other authors include Robert J. Adams, M.D.; Thomas Brott, M.D.; Gregory J. del Zoppo, M.D.; Anthony Furlan, M.D.; Larry B. Goldstein, M.D.; Robert L. Grubb, M.D.; Randall Higashida, M.D.; Chelsea Kidwell, M.D.; Thomas G. Kwiatkowski, M.D.; John R. Marler, M.D.; and George J. Hademenos, Ph.D.

For more information on stroke, visit the American Stroke Association Web site: www.strokeassociation.org.

University of Iowa Health Care describes the partnership between the UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide. Visit UI Health Care online at www.uihealthcare.com.

STORY SOURCE: Joint Office for Planning, Marketing and Communications, University of Iowa Health Care, 200 Hawkins Drive, Room 8798 JPP, Iowa City, Iowa 52242-1009.

CONTACT: Tom Moore, 319-356-3945, thomas-moore@uiowa.edu
Writer: Carole Bullock.

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