Stroke Victims Should Take Ambulance

Not only is it important for someone experiencing stroke symptoms to get to the hospital as fast as possible, but the way a patient gets there is also important, the author of a recent study concludes.

There is a three-hour window during which a stroke patient can be administered the clot-busting drug that gives them the best chance to avoid a stroke-related disability, such as paralysis, said Dr. Mathew Reeves, of Michigan State University in East Lansing.

Unfortunately, few people get to the hospital in time to receive the drug recombinant tissue plasminogen, or tPA, according to a study in the Feb. 14 issue of Neurology.

Several factors increased the chances that tPA would be given. Those who arrived at the hospital by ambulance were seven times more likely to receive tPA than those who arrived on their own.

"People need to learn the warning signs of stroke and call 911 immediately if they think someone might be having a stroke," Reeves said. "A stroke is an emergency, and we now have treatments that can help."

But there's more. It appears to be better to go via an ambulance if you or someone you know is exhibiting symptoms of a stroke.

"People who arrive by ambulance are seen and evaluated more quickly in the emergency department," Reeves said. "This is probably due to a combination of reasons. EMS transport allows the emergency department to be notified that an acute stroke case will be arriving. The paramedics are also able to do some simple but important background steps in the ambulance - such as completing a rapid neurological exam, putting in an IV line and drawing blood.

"These steps allow the hospital to then 'fast track' the patient through the emergency department, thus increasing the chance of meeting the three-hour deadline for tPA treatment."

The study involved 15 hospitals in Michigan. Researchers identified everyone who was admitted to the hospital with a stroke over a six-month period. Of the 2,097 people who had strokes involving blood clots, only 43 people, or 2 percent, received tPA. Of those who did not receive tPA, 41 percent arrived at the hospital more than three hours after the first symptom started.

Women were 60 percent less likely to receive tPA than men. The sooner people arrived at the hospital within the three-hour window, the more likely they were to receive tPA. Those who arrived during the second hour after symptoms first occurred were 50 percent less likely to receive tPA than those who arrived within the first hour. Those who arrived two to three hours after symptoms started were 33 times less likely to receive tPA.

WARNING SIGNS

Doctors recommend heading to the hospital right away if you experience any of the following symptoms:

- Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.

- Sudden confusion, trouble speaking or understanding.

- Sudden trouble seeing in one or both eyes.

- Sudden trouble walking, dizziness, loss of balance or coordination.

- Sudden severe headache with no known cause.

ESTROGEN THERAPY

Estrogen therapy does not appear to reduce the risk of heart attack or coronary death in healthy postmenopausal women, although some data suggest a lower coronary heart disease risk in women aged 50 to 59, according to an article in the Feb. 13 issue of Archives of Internal Medicine.

The Women's Health Initiative, or WHI, included two large clinical trials that evaluated whether hormone therapy with estrogen reduces the risk of coronary heart disease in postmenopausal women, according to the article.

"It was neutral with regard to heart disease," said study author Dr. Judith Hsia, a professor of medicine at George Washington University in Washington, D.C.