Brain & Nervous System Stroke How Tissue Plasminogen Activator (tPA) Works for Stroke By Jose Vega MD, PhD linkedin Jose Vega MD, PhD, is a board-certified neurologist and published researcher specializing in stroke. Learn about our editorial process Jose Vega MD, PhD Medically reviewed by Medically reviewed by Claudia Chaves, MD on January 13, 2020 Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts. Learn about our Medical Review Board Claudia Chaves, MD Updated on October 22, 2020 Print Tissue plasminogen activator, or tPA, is the only FDA-approved treatment for ischemic or thrombotic stroke, which is stroke caused by a blood clot interrupting blood flow to a region of the brain. Chris Ryan / Getty Images It has also been used in treatment for pulmonary embolism and myocardial infarction. TPA is a blood thinner, and therefore it is not used for hemorrhagic strokes or head trauma. How It Works TPA is a naturally occurring protein found on endothelial cells, the cells that line blood vessels. It activates the conversion of plasminogen to plasmin, an enzyme responsible for the breakdown of clots, helping restore blood flow to the brain. It is a powerful medication that must be administered by an experienced medical team. Before tPA Treatment Prior to receiving treatment with tPA, you should expect to have a brain computerized tomography (CT) scan. This is because there are several medical conditions that make it too dangerous for you to receive tPA. If you have any of these conditions, not only would tPA not help you, it could cause significant harm to your health. Conditions that would make you ineligible to receive treatment with tPA include: Hemorrhagic stroke (bleeding in the brain)Brain aneurysm or AVMRecent surgical procedureHead injuriesBleeding or blood clotting disordersBleeding ulcersPregnancyBlood-thinning medicationTraumaUncontrolled high blood pressure Administration of tPA Treatment with tPA has been effective for people with an ischemic stroke as long as it is received intravenously within up to 3 hours of the onset of symptoms. Endovascular treatment to deliver tPA at the site of the clot or retrieval of the clot is considered for up to 24 hours after a stroke. Guidelines for the treatment of acute stroke published by the American Heart Association in 2018 strongly recommend IV altephase (tPA) within 3 hours of stroke symptoms onset for eligible patients. This treatment approach has been shown to produce the best overall outcomes. Protocols have been established to rapidly identify whether you could be having a stroke, so that your testing and treatment can be prompt and efficient, allowing you to receive life-saving treatments in a timely manner. In fact, some centers are making strides in diagnosing stroke sooner than ever before via mobile stroke units. Side Effects While tPA has been shown to be beneficial in the treatment of stroke, there is a risk associated with tPA treatment, even for people who have been medically cleared for tPA. It is a powerful blood thinner, and serious side effects may occur, including the following: Hemorrhage (bleeding) affecting the brain: Causes headaches, weakness, confusion, loss of consciousness, seizuresHemorrhage of the digestive system: Causes blood in the stool or stomach painSevere blood loss: Causes lightheadedness, low blood pressure, loss of consciousnessMinor bleeding in the gums or noseBlood in the urine If you experience any of these side effects, you should immediately inform your medical team. Recognizing Symptoms of a Stroke The best way to maximize your chances of receiving the most effective treatment for a stroke is to get to the emergency room as soon as possible. A person who is having a stroke may not notice when they are experiencing symptoms. You can learn how to recognize a stroke so that you can get immediate help. Don’t wait for the symptoms to disappear. The sooner a stroke is treated, the fewer the long-term effects. Symptoms of a stroke include: Trouble understanding words or speakingNumbness of the arm, face, or legBlurred or blackened vision in one or both eyesDouble visionSudden, severe headacheVomitingDizzinessDifficulty walkingLoss of balance or coordinationWeakness of the face, arm or legDroopy face or eyelidConfusion Signs and Symptoms of Stroke A Word From Verywell Stroke prevention is a vital part of a healthy lifestyle. While treatments are becoming more effective for reducing the serious consequences of a stroke, prevention is the most effective way to avoid the consequences of stroke. Ways to control risk factors for a stroke include: Quitting smokingLosing weightIncreasing physical activityReducing alcohol intakeEliminating illegal drug usageLowering cholesterol and fat levelsManaging diabetes if you have itMaintain a healthy blood pressure If you or a loved one has had a stroke or has received tPA for treatment of a stroke, expect a recovery that may take time. Stroke Recovery and Rehabilitation Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. UptoDate. Patient education: Ischemic stroke treatment (Beyond the Basics). Updated Apr 08, 2019. American Stroke Association. Why getting quick stroke treatment is important. Merck Manual Consumer Version. Ischemic stroke. Updated February 2018. Powers WJ, Rabinstein AA, Ackerson T, et al; American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2018 Mar;49(3):e46-e110. doi: 10.1161/STR.0000000000000158. Fernandez-gotico H, Lightfoot T, Meighan M. Multicenter study of adverse events after intravenous tissue-type plasminogen activator treatment of acute ischemic stroke. J Neurosci Nurs. 2017;49(1):31-36. doi:10.1097/JNN.0000000000000247 American Stroke Association. Stroke symptoms. American Stroke Association. Preventing another stroke. Additional Reading Christophe BR, Mehta SH, Garton AL, Sisti J, Connolly ES Jr. Current and future perspectives on the treatment of cerebral ischemia. Expert Opin Pharmacother. 2017;18(6):573-580. doi:10.1080/14656566.2017.1309022