It’s not just the studies he’s read throughout the years that convinced Dr. Arthur Moore – it was seeing the difference that the clot-busting drug tPA can make in the lives of ischemic stroke patients.
“The benefit with tPA amounts to about a 30 percent increased chance of minimal to no deficit and able to live on your own at three months,” says Dr. Moore, medical director of the Comprehensive Stroke Center at Fort Sanders Regional Medical Center. “It’s not an overnight thing, but we’ve seen it turn patients around.”
Still, he says, the greatest obstacle to reducing death and disability due to stroke remains education of stroke’s warning signs and tPA – and not just educating the patients but health providers, too.
“It starts with recognition on the patient’s part,” he said. “Patients will wake up at night and not be able to move one side and go back to sleep. They’ll say, ‘Awww, it’ll be better in the morning.’ Well, by the time they wake up in the morning, I can’t do anything. That stroke is already there. So that’s No. 1 – increased recognition.
“Then, it’s increased recognition on the part of Emergency Medical Services and people in emergency departments where they say, ‘This is a stroke’ but willing to take it one step further: ‘This is a stroke and I can treat this.’ It’s recognizing that tPA does have benefits. It’s saying, ‘We CAN treat this patient and they CAN get better.’ And if they can’t do it there at one hospital, it’s recognizing that they need to go to a higher level of care.”
“Once we start educating people and they’re recognizing and getting to the hospitals, that’s great,” Dr. Moore continued. “But if you have a bottleneck in the hospital – if you sit around for an hour and a half and see if it gets better before we think about giving the medicine – that’s the wrong way to approach it. We need to approach it as the emergency that it really is.”
Yet, failure to recognize those signs and seek treatment quickly continues to contribute to take a toll on the 800,000 victims each year, causing it to be the third-leading causes of death and No. 1 cause of disability each year in the United States.
Certainly, tPA carries risks — a 6 percent chance of bleeding with a 3 percent chance of worsening the symptoms and 1 percent risk of death. Even so, most patients elect to take tPA rather than face a life of disability in a nursing home.
Dr. Moore says FSRMC is expected to handle hundreds of stroke cases this year. Of those, he projects about a fifth will be eligible to receive tPA. “It’s highly variable but here lately we’ve been averaging about 10 times a month,” he says. “We’re quite a bit higher than the national spectrum as far percentage of patients. We have a goal this year of greater than 20 percent of not only getting tPA to obviously eligible patients, but getting those patients here in enough time to where we can do it. We want to be aggressive because we are comfortable with the medicine. We know what we are doing and when we give it, it helps patients.”