this was really interesting meir.

--- Meir Weiss <[log in to unmask]> wrote:

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> -bb3a-4ebc-a538-d100e0430016
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>
>  Tuesday > May 10 > 2005
>
> Doctors snub stroke drug
> Researchers challenge reluctance to use clot-busting
> medication
>
> SHARON KIRKEY
> CanWest News Service
>
>
> Tuesday, May 10, 2005
>
>
> More than one-third of stroke patients injected with
> clot-busting drugs
> survive without significant brain damage, according
> to new Canadian
> research that backs aggressive use of medication
> many emergency doctors
> have been reluctant to use.
>
> The nationwide study, which involved nearly 1,200
> stroke patients at 60
> hospitals, found the drug alteplase works better
> than expected and that
> the most feared side-effect - bleeding in the brain
> - occurs in fewer
> than five per cent of patients.
>
> But fewer than two per cent of stroke victims
> received the drug over the
> 1999-2001 study, researchers estimate.
>
> "My guess is that, across the country, we're
> probably not much better"
> today, said co-
>
> author Michael Hill, a stroke neurologist at the
> University of Calgary.
>
> Part of the problem is that 70 per cent of stroke
> patients don't get to
> the hospital in time to be eligible for a clot
> buster.
>
> But another recent study found that nearly 10 years
> after its U.S.
> approval, the drug still meets strong resistance
> from doctors.
>
> A survey of 1,105 emergency physicians in the United
> States published
> online last week in the Annals of Emergency Medicine
> found 40 per cent
> said it was unlikely they would give the drug "to an
> ideal patient in an
> ideal setting."
>
> Of them, 65 per cent cited the concern over
> hemorrhage, according to
> University of Michigan researchers.
>
> Twenty-three per cent said they didn't think the
> drug would provide
> benefit, while 12 per cent gave both reasons.
>
> Every year, 50,000 Canadians suffer a stroke, making
> it the No. 1 cause
> of long-term disability.
>
> Almost 80 per cent of all strokes are ischemic
> strokes, where a blood
> clot lodges in a vessel in the brain, squeezing off
> the flow of
> oxygen-rich blood to that area.
>
> Clot-busters can quickly dissolve the obstruction
> and, if given within
> three hours of the onset of symptoms, stop neurons
> from dying. But the
> drugs can also induce bleeding, including in the
> brain - with fatal
> results.
>
> The new study, published in today's issue of the
> Canadian Medical
> Association Journal, found 37 per cent of ischemic
> stroke patients
> treated with alteplase had an "excellent" outcome.
>
> That means "they might have a little facial droop or
> a little numb hand
> or that kind of thing, but they can get back to all
> their previous
> activities, including driving," Hill said in an
> interview.
>
> Alteplase is a genetically engineered version of
> tissue plasminogen
> activator, or tPA, a naturally occurring enzyme that
> breaks down clots.
>
> TPA for stroke was conditionally licensed in Canada
> in 1999. As a
> condition of approval, Health Canada ordered a
> registry be created to
> monitor "real world" use of the drug.
>
> For the study, data were collected from 1,135
> patients - nearly 85 per
> cent of all patients treated with tPA between
> February 1999 through June
> 30, 2001. The patients were followed for up to 90
> days; the median age
> was 73.
>
> Using census data, the researchers estimated that
> 1.4 per cent of 90,200
> patients with ischemic stroke received tPA during
> the study period, a
> low rate given "good access to basic technology such
> as CT scanning" in
> hospitals.
>
> An intracranial hemorrhage - brain bleeding -
> occurred in 52 of patients
> treated, or 4.6 per cent. Thirty-nine died in
> hospital, and one
> recovered to a level of "functional independence."
>
> "There was a three per cent rate of fatal
> hemorrhage," Hill said. "That
> means that 97 per cent of the time you don't kill
> someone - but you can
> kill someone with the treatment.
>
> "That's the worry. No doctor wants to do that. On
> the other hand, the
> other side of it is that if you don't treat them,
> they often die from
> their stroke."
>
> About one-fifth of the patients died of their
> strokes, while 25 per cent
> had a "moderate" outcome, meaning "they were not
> back to work, not
> playing golf. It means they were disabled enough it
> impaired their
> life," Hill said. The rest were left with more
> severe disabilities.
>
> Neurologists most often administered the drug. "But
> we're hoping that
> ... we'll be able to continue to educate people and
> get this treatment
> into the hands of more physicians," Hill said.
>
> It costs about $15,000 to $18,000 in drugs and
> hospital care to treat
> one patient with tPA, vs. "about $100,000 to take
> care of severely
> disabled person for a year," Hill said.
>
> The study was paid for by the Canadian Stroke
> Consortium, the Canadian
> Stroke Network and Hoffmann-La Roche Canada Ltd.
>
> C The Gazette (Montreal) 2005
>
>
>
>
>
>
>
>
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