Tissue Plasminogen Activator (tPA)
opportunity to use alteplase (tPA) as a clot-buster drug to dissolve the blood
clot that is causing the stroke. There is a narrow window of opportunity to use
this drug. The earlier that it is given, the better the result and the less
potential for the complication of bleeding into the brain.
American Heart Association guidelines recommend that if used, tPA must be given
within 4 ½ hours after the onset of symptoms and ideally within 3 hours. For
patients who waken from sleep with symptoms of stroke, the clock starts when
they were last seen in a normal state.
injected into a vein in the arm. The time frame for its use may be extended to
6 hours if it is dripped directly into the blood vessel (intra-arterial) that
is blocked requiring angiography. Not all hospitals have access to this
technology. It had been hoped that using the same technique, the clot could be
identified and removed by suction. Unfortunately, studies show that patient
outcomes were not improved compared with tPA therapy.
reverse stroke symptoms in more than one-third of patients, but may also cause
bleeding in 6% of patients, potentially making the stroke worse.
involving the cerebellum of the brain and involving the vertebroasilar circulation,
the time frame for treatment with tPA potentially may be extended even further
to 18 hours.
Heparin and aspirin
Drugs to thin
the blood are also sometimes used in treating stroke patients in the hopes of
improving the patient’s recovery. It is unclear, however, whether the use of
anticoagulation improves the outcome from the current stroke or simply helps to
prevent subsequent strokes. In certain patients, aspirin given after the onset
of a stroke does have a small, but measurable effect on recovery. The treating
doctor will determine the medications to be used based upon a patient’s specific
Managing other medical problems
pressure will be tightly controlled often using intravenous medication to prevent
stroke symptoms from progressing. This is true whether the stroke is ischemic or
oxygen is often provided.
with diabetes, the blood sugar (glucose) level is often elevated after a
stroke. Controlling the glucose level in these patients may minimize the size
of a stroke.
have suffered a transient ischemic attack may be discharged with blood pressure
and cholesterol medications even of the blood pressure and cholesterol levels
are within acceptable levels. Smoking cessation is mandatory.
patient is no longer acutely ill after a stroke, the health care staff focuses
on maximizing the individual’s functional abilities. This is most often done in
an inpatient rehabilitation hospital or in a special area of a general
hospital. Rehabilitation can also take place at a nursing facility.
rehabilitation process can include some or all of the following:
therapy to relearn talking and swallowing.
therapy to regain as much function and dexterity in the arms and hands as
therapy to improve strength and walking.
education to orient them in caring for their loved one at home and the
challenges they will face.
The goal is
for the patient to resume as many, if not all, their pre-stroke activities and
functions. Since a stroke involves the permanent loss of brain cells, a total
return to the patient’s pre-stroke status is not necessarily a realistic goal
in many cases. However, many stroke patients can return to vibrant independent
upon the severity of the stroke, some patients are transferred from the
rehabilitation hospital setting to a skilled nursing facility to be monitored
and continue physical and occupational therapy.
home health workers can assess the home living situation and make
recommendations to ease the transition home. Unfortunately, some stroke
patients have such significant nursing needs that they cannot be met by
relatives and friends. Long-term nursing care may be required.
To reach one of our Advanced Senior Solution’s team members, either go to the Contact Us tab or call 727-443-2273. We’re here to help with all of your elder care questions, care needs, and much more! Call us today for a free no-obligation care consultation via phone or in person.