Tissue Plasminogen Activator (tPA) for Stroke

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. It has 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.

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. TPA works by preventing the enlargement of blood clots that obstruct the flow of blood in the brain. It is a powerful medication that must be administered by an experienced medical team.

Prior to receiving treatment with tPA, you should expect to have a brain 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 AVM
• Recent surgical procedure
• Head injuries
• Bleeding or blood clotting disorders
• Bleeding ulcers
• Pregnancy
• Blood thinning medication
• Trauma
• Uncontrolled high blood pressure

Treatment with tissue plasminogen activator (tPA) has been effective for people with an ischemic stroke as long as it is received intravenously within three hours of onset of symptoms. Endovascular treatment to deliver tPA at the site of the clot or retrieval of the clot is considered for up to nine hours after a stroke.

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, with mobile stroke units.

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, seizures
• Hemorrhage of the digestive system- causes blood in the stool or stomach pain
• Severe blood loss- causes lightheadedness, low blood pressure, loss of consciousness
• Minor bleeding in the gums or nose
• Blood in the urine

If you experience any of the side effects, you should inform your medical team.

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 if you notice signs or symptoms of a stroke.

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 or speaking
• Numbness of the arm, face or leg
• Blurred or blackened vision in one or both eyes
• Double vision
• Sudden, severe headache
• Vomiting
• Dizziness
• Difficulty walking
• Loss of balance or coordination
• Weakness of the face, arm or leg
• Droopy face or eyelid
• Confusion
• Loss of consciousness

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 smoking
• Losing weight
• Increasing physical activity
• Reducing alcohol intake
• Eliminating illegal drug usage
• Lowering cholesterol and fat levels
• Managing diabetes if you have it
• Maintain 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. The post stroke checklist can be used to help guide you and your family through your recovery.