MSN, RN – Chief Nursing Officer
Stroke – Precise timing – Thrombolytic medications – Limited therapeutic window – Efficacy – Effectiveness. Each of these words describes the top issues discussed among stroke patients once a diagnosis has been confirmed.
When a stroke occurs, there is only a small percentage of patients that are successfully able to be treated with thrombolytic medications which assist in the above-mentioned factors.
In 1995, the National Institute of Neurological Disorders and Stroke (NINDS) completed a study that involved patients with acute ischemic stroke that received an intravenous thrombolytic known as Alteplase (tPA – tissue plasminogen activator) within three hours after the onset of symptoms.
The study revealed that patients who received intravenous Alteplase were 30% more likely to have minimal to no disability at a three-month interval post-acute ischemic attack versus those patients who received only a placebo.
It was also noted that at the one-year follow-up for patients treated with Alteplase that there was minimal to no disability. Despite its overall effectiveness, questions remain such as the following and must be thoroughly evaluated when deciding about the use of Alteplase among stroke patients:
According to guidelines set forth by the American Heart Association (AHA) and the American Stroke Association (ASA), it is recommended that Alteplase be administered for selective patients experiencing acute ischemic stroke within three hours of onset of symptoms.
The symptoms that may be noted are sudden numbness or weakness of the face, arm, or leg and typically occurs on one side of the body; confusion that started suddenly; difficulty speaking; difficulty walking; vision problems; sudden dizziness, loss of balance, or coordination; and severe headache with no apparent cause.
When these symptoms occur, it is typically due to an acute ischemic stroke (AIS) which involves sudden decreased blood flow to an area of the brain that results in the loss of neurologic functioning. The decrease in blood flow is due to a thrombosis or embolism that creates occlusion in a cerebral vessel that supplies blood to a specific area of the brain.
Often times, symptoms of an acute ischemic stroke may be considered “silent signs” and the top four silent signs are a sudden headache, problems with loss of balance and vision, numbness on one side of the body, and difficulty speaking.
Due to the critical time period for thrombolytic agents to be administered, the acronym F.A.S.T. has been utilized to assist those with identifying strokes in a timely manner.
Alteplase can be used as an effective means of treatment in certain patients as long as the crucial time frame has been maintained. However, there is strong indication that treatment of Alteplase may still be beneficial between 3 – 4.5 hours and can still be utilized and offered during this time frame.
The intervention of Alteplase is fairly simple. It is administered in a dose of 0.9mg/kg body weight as a bolus (which is equal to 10% of the total dose) and then it is followed by the remaining 90% of the dose as an infusion over a one-hour period of time.
It is important to understand the reasoning for those patients who may not be eligible for Alteplase and the contraindications are listed below:
Alteplase works by intravenous injection. It’s main function is to dissolve any blood clots that block the adequate flow of blood to the brain. Alteplase is primarily cleared by the liver and has an initial half-life of fewer than 5 minutes and a terminal half-life of 72 minutes. Alteplase works by attaching itself to the fibrin on the surface of the clot and it activates the fibrin-bound plasminogen.
The plasmin is divided from the plasminogen affiliated with the fibrin and the molecules of fibrin break causing the clot to dissolve.
As with any medication, the potential for side effects is present.
The following are considered side effects of Alteplase and are divided into the more common side effects and the rare side effects:
Most Common Side Effects
Rare Side Effects
The occurrence of a stroke can vary for each individual and can be a serious and difficult experience for the patient undergoing a stroke and for the family members/caregivers that may witness the event. The administration of Alteplase in the recommended time period has proven to be crucial to a patient’s survival, recovery, and any debilitating conditions that may result from the stroke.
Early treatment remains essential, and the effect of thrombolysis is totally dependent on time. When a patient experiences a stroke, he/she should be treated with Alteplase as early as possible to maximize the full benefits and to increase the overall recovery period.
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