Your experience with TPA

[irishnurse2011]

I have been lead to believe that within minutes or hrs after someone is given TPA, there should be instant improvement in their condition/symptoms. Is this accurate?

Here is what the National Stroke Association's website had to say:

"a five-year trial, conducted by the National Institute of Neurological Disorders and Stroke (NINDS) found that carefully selected stroke patients who received Activase within three hours of the beginning of stroke symptoms were at least 33 percent more likely than patients given a placebo to recover from their stroke with little or no disability after three months."

Three months? So what does that mean? That the success of the drug can be seen in minutes or hrs after the stroke BUT also 3 months later??

I read another news article where they say:

"The articles always seem to include an anecdote where some one gets tpA and jumps off the table instantly cured. This is not supported by the literature where the gains are actually small functional improvements down the road.

Can someone relay to me their knowledge and experience about TPA?

[medicaltransportflorida]

Hi Thank you for the good write-up. about TPA It in fact was an amusement accounts it. Look advanced to more add agreeable from you!

[chaosunlimited]

I have given tPA quite a few times. In most cases, I have seen signs of improvement in less than an hour. Instant improvement is not the same as instant recovery. Many that I have seen getting tPA begin to have voluntary movement in a previously flaccid extremity within minutes of receiving the initial bolus. Of course, no one jumps off the table instantly cured, but we begin to see signs of improvement in terms of their deficits reversing. There are some where I haven't seen any improvement initially, but hear back later that over hours or days there was improvement.

What the study is saying, is that they compared stroke patients recovery either at, or up until 3 months after their stroke. The ones who received tPA were 33% more likely to have a return to normal, or close to normal functioning by that time than the patients who did not receive tPA.

So, for some people, getting tPA can mean the difference between having use of both arms and legs, or being partially paralyzed. As another example, it can also mean the difference between having intelligible speech, or slurred speech.

[jayne1975]

"a five-year trial, conducted by the National Institute of Neurological Disorders and Stroke (NINDS) found that carefully selected stroke patients who received Activase within three hours of the beginning of stroke symptoms were at least 33 percent more likely than patients given a placebo to recover from their stroke with little or no disability after three months."

Three months? So what does that mean? That the success of the drug can be seen in minutes or hrs after the stroke BUT also 3 months later??

I read another news article where they say:

"The articles always seem to include an anecdote where some one gets tpA and jumps off the table instantly cured. This is not supported by the literature where the gains are actually small functional improvements down the road.

Can someone relay to me their knowledge and experience about TPA?

My personal experience with tPA - Woman with right gaze deviation as one of the primary visible signs of a stroke. You could walk into the room and she could not see you unless you walked into her line of sight. Started tPA and after approximately 20 minutes, she could track you with her gaze across the room. Resuming normal eye movement within that short period of time. Because this was initiated in the ER, I didn't get to follow through with that patient, so I don't know the outcome 3 days post treatment, much less 3 months....

From the quote you posted.... it says that they suffered little or no disability after 3 months... not that it took that long for the tPA to reach its effectiveness.

The issue is not the quote, but how you interpreted the information. Even using tPA to dissolve a clot that has caused a stroke will not make a patient improve back to their baseline, but you should see some improvement within the first hour treatment is initiated. The tissues distal to the blockage have been deprived of their normal blood supply for a period of time and if that portion of the brain has been without supply for long enough, that part of the brain will die. The cells do not regenerate and in order to return to a normal level of function, a patient will have to 'relearn' those tasks that no longer have normal neuro-pathways in the brain specific to that person.
With tPA you are saving brain tissue that is going to be lost without intervention. You cannot resume normal blood flow to brain cells that have already ceased functioning completely, but you are going to save the cells near the blockage who haven't completely ceased to function.

A very generalized and fictitious analogy:
You have 10 scuba divers all hooked up to one boat, using one compressor to receive their oxygen. A random piece of litter gets dropped into the compressor and blocks the air to 3 divers and starts to make the compressor not as effective. The 3 divers with no oxygen die...the other 7 divers are still getting oxygen at a much lower rate, but unless someone fixes the compressor, they are going to die as well.
tPA is the litter remover in this scenario. Once you've given the tPA, the litter is dissolved and the compressor resumes normal function. Some of the 7 divers may have lasting problems from the oxygen deprivation, but the 3 you lost are lost forever. After some time, some treatment and rehab, the 7 divers return to normal function and some of them even learn to do the jobs of those divers who were lost.
Now, replace the divers with brain tissue and the litter for a clot... and you have a very generalized view of how tPA works.