TPA- Tissue Plasminogen Activator for Stroke

Tissue plasminogen activator, most commonly known as TPA, is a powerful blood thinner used for emergency stroke treatment. Approved 20 years ago for the treatment of stroke, it was initially viewed as both revolutionary and risky. Now, twenty years later, stroke treatment has advanced a lot, but TPA is still the most dramatic improvement to come about in the care of stroke patients.

Stroke outcomes are far better nowadays than they were prior to the use of TPA for stroke. If you or a loved one has had emergency TPA for a stroke, you can learn more about it here.

Tissue plasminogen activator is a powerful agent that can prevent a developing blood clot from growing. It is injected by intravenous administration (IV) for emergency stroke treatment.

A stroke is caused by an interruption in blood flow either due to a blood clot (ischemic stroke) or a bleed (hemorrhagic stroke) in the brain. TPA is only used for strokes caused by blood clots, which are ischemic strokes.

When TPA is injected into a vein, it quickly travels through the blood to reach the clogged blood vessel, where it works by preventing the growing blood clot from obstructing blood flow in the brain. This allows the brain to remain healthy before stroke damage can occur.

TPA has to be administered within the first few hours after a stroke begins. The start of a stroke is counted from the time that you first noticed stroke symptoms. After this very short window of a few hours after a stroke starts, you cannot receive TPA because it might cause more harm than good at that point.

Most of the time, patients do not ask for TPA. But emergency medical workers are trained to recognize a stroke and emergency rooms are equipped with the staff and provisions to administer TPA when it is necessary.

Over the past twenty years, numerous patients have had TPA. The long-term and short-term effects of TPA have been carefully evaluated. Overall, in the right circumstances, TPA has been proven to be beneficial.

A recent comparison of stroke patients who did receive TPA to stroke patients who did not receive TPA showed that the group of patients who were treated with TPA experienced better physical function, better cognitive abilities, and better survival rates than the stroke patients who did not get the TPA treatment.

The sooner stroke patients receive TPA, the better the recovery. For every 15-minute interval that stroke patients receive TPA treatment sooner, stroke survivors have better overall outcomes. In fact, a recent national quality improvement initiative aimed at reducing the waiting time for TPA administration improved patients’ survival and decreased complications of TPA treatment.

Because TPA is a powerful blood thinner, the main side effect is bleeding. Bleeding is a serious complication that can result in a hemorrhagic stroke, which is often more serious than an ischemic stroke.

Additionally, TPA can cause stomach bleeding, intestinal bleeding, bleeding in the urine or bleeding of healing wounds or surgical incisions. For these reasons, some patients are not candidates for TPA.

TPA is very fast acting and its effect does not last very long. If you have received TPA and did not experience any side effects or complications within the first few days, you do not need to be concerned about delayed or long-term side effects from the TPA during your recovery or after you go home.

Find out how mobile stroke units in some cities can help stroke patients receive treatment faster.

TPA is an important stroke treatment that can save your life. However, it can be dangerous and not everyone is a safe candidate for TPA. Also, if the narrow time interval has elapsed by the time you reach the hospital, you cannot receive TPA treatment because it is only beneficial if it is given within the first few hours after a stroke has started.

Sources:

Safety of intravenous thrombolysis for acute ischemic stroke in specific conditions, Tsivgoulis G, Safouris A, Alexandrov AV, Expert Opinion on Drug Safety, April 2015

A case-control study of the effectiveness of tissue plasminogen activator on 6-month patients--reported outcomes and health care utilization, Lang CE, Bland MD, Cheng N, Corbetta M, Lee JM, Journal of Stroke and Cerebrovascular Disease: the official journal of National Stroke Association, November- December 2014 

Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke, Saver JL, Fonarow GC, Smith EE, Reeves MJ, Grau-Sepulveda MV, Pan W, Olson DM, Hernandez AF, Peterson ED, Schwamm LH, JAMA, June 2013

Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative, Fonarow GC, Zhao X, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Xian Y, Hernandez AF,Peterson ED², Schwamm LH, JAMA, April 2014