Lysis therapy in stroke within 4.5 hours

Stroke treatment: Lysis therapy within 4.5 hours

01/14/2015

Every year, over a quarter of a million people in Germany suffer a stroke. Critical to a successful treatment is that patients are treated as quickly as possible on a so-called stroke unit. A new study now confirms that lysis therapy should be performed within 4.5 hours of the stroke.

Also effective in the elderly
Every year more than a quarter of a million people in Germany suffer a stroke. After a cerebral infarction, it has to be fast. As reported by representatives of the German Stroke Society (DSG) and the German Neurological Society (DGN), a new study shows that the treatment results for patients are better the earlier the so-called lysis therapy is initiated. In the lysis therapy, blood clots in the cerebral artery are dissolved by infusion with the enzyme alteplase. The results of the meta-analysis of nine major therapeutic trials were recently published in the journal „The Lancet“ released. The investigation confirmed that lysis treatment is effective in a 4.5 hour post-stroke window, even in the elderly.

Best results for treatment within three hours
The results are therefore best when the treatment begins within the first three hours. In addition, the chances of a patient surviving the stroke without severe disability were 75 percent higher than in the control group who did not receive lysis therapy. When lysis was started three to 4.5 hours after the stroke, the benefit was still 26 percent. „Our results confirm the effect of lysis in the 4.5 hour time window“, explained Professor Werner Hacke of the University Hospital Heidelberg. At a later date, however, their use always remains an isolated decision. Hoe is head of the „Stroke Thrombolysis Trialists' Collaborative Group“, who did the meta-analysis. For the analysis, the international research team evaluated data from all 6,756 study participants individually in order to obtain as unadulterated a picture of the effectiveness and possible risks as possible.

Doctors are wary of elderly patients with lysis therapy
The German Stroke Society (DSG) also considers the new results to be important, as many doctors are still reluctant to use lysis therapy, particularly among older patients. „The fear of complications is widespread“, explained Professor Joachim Röther, press spokesman of the DSG and chief physician of the Neurological Clinic at the Asklepios Clinic Altona. Since around a quarter of the subjects were older than 80, the current meta-analysis provided reliable results for the first time. „The success rate of lysis therapy was by no means worse in very elderly, and the results tended to be even better“, so Röther. The expert also sees no problems regarding the risk of bleeding in elderly patients.

Stroke is „always an emergency“
Since bleeding is the most dreaded complication of lysis therapy, the German Neurological Society points out that the dissolution of the blood clot should always be preceded by a computerized or MRI scan to rule out cerebral hemorrhage as the cause of the stroke. „Although the examination delays the start of therapy, a well-organized stroke unit with appropriately qualified staff can compensate for this“, said DGN spokesman Professor Hans-Christoph Diener. In addition, the education of the population is important. „The relatives need to know that a stroke is always an emergency, even if sufferers have no pain.“ Symptoms that can be signs of stroke include numbness, tingling, speech and vision problems, gait insecurity, and sudden headaches. The main risk factor for a stroke is hypertension, according to experts. Therefore, it is always advised to live healthier, for example by more exercise, weight loss, better nutrition and abstaining from smoking.

Effectiveness has been proven for 20 years
„The efficacy of lysis therapy was first demonstrated in a clinical study nearly 20 years ago, and lysis is now firmly established on all certified stroke units in Germany“, explained Professor med. Hans-Christoph Diener, Director of the Department of Neurology at the University Hospital Essen. Nevertheless, in Germany it is only performed in around ten percent of stroke patients. „This is mainly because only about 30 to 40 percent of stroke patients reach the clinic in time“, explained the expert. In some European countries, this treatment is not recommended for mild or very severe strokes, and for people over 80 years of age. However, this is not the case with Germany. (Ad)