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New hope for stroke victims
DRUG
CONSULT
New Hope for Stroke Victims BY
CAROL
A.
MILLER
any patients in subacute and skilled nursing care fa.cilities are recovering from strokes, which were virM tually untreatable before 1996. Stroke is the leading cause of disability and the third leading cause of death in the United States. It is hoped that these statistics will change during the next decade as new treatments become available for reversing or halting the devastating effects of strokes. In June 1996 the Food and Drug Administration approved the first drug to treat ischemic strokes, which account for 70% to 80% of all strokes. This drug, called alteplase (Activase) or t-PA, is a tissue plasminogen activator that has been used in the treatment of heart attacks. This drug dissolves blood clots and restores blood flow to the tissue. Results of a 5-year clinical trial of more than 600 patients with strokes found that patients who received t-PA treatment within 3 hours of their initial symptoms were at least 30% more likely to recover from their stroke with little or no disability after 3 months. 1 Dangers of t-PA treatment include a slightly increased risk of brain hemorrhage, but overall the benefits far outweigh the risks. One major limitation of t-PA treatment is the need for the drug to be administered within 3 hours of the onset of symptoms. Thus to benefit from this major breakthrough in the treatment of strokes, patients and their families need to recognize the warning signs of stroke, and they need to seek immediate medical attention at a hospital that is prepared to evaluate and treat patients with strokes. This requires a major health education effort to reverse and correct the current perception that strokes and transient ischemic attacks are untreatable conditions that do not warrant emergency evaluation. Gerontologic nurses can play an important role in educating older adults and their families about the warning signs of stroke and the need for immediate evaluation (Box 1). A previous "Drug Consult" column provided guidelines for education about the prevention of strokes through lifestyle adaptations and medical interventions, a National Stroke Awareness Month in May is an ideal time to begin incorporating health care education about the prevention and treatment of strokes. Free health edu-
cation materials can be obtained from the National Institute of Neurological Disorders and Stroke at the National Institutes of Health, Bethesda, MD 20892. These materials are also available through the Internet at
htpp://www.ninds.nih, gov/healinfo/disorder/stroke/stroke ws.htm Free educational materials are also available from the National Stroke Association at (800) 787-6537 and the American Heart Association at (800) 242-8721. • REFERENCES 1. The National Institute of Neurological Disorders and Stroke tPA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1996;333:1581-7. 2. Miller CA. The nurses' role in preventing "brain attack." Geriatr Nurs 1994;15:227-8.
CAROL A. MILLER, RN-C, MSN, is a gerontologic nurse specialist with Care & Counseling, MillerAVetzler Associates, Cleveland, Ohio. Geriatr Nurs 1997;18:131. Copyright © 1997 by Mosby-Year Book, Inc. 0197-4572/97/$5.00 + 0 34/1/81374
GERIATRIC NURSING Volume 18, Number 3
Miller
131
CONSULT
New Hope for Stroke Victims BY
CAROL
A.
MILLER
any patients in subacute and skilled nursing care fa.cilities are recovering from strokes, which were virM tually untreatable before 1996. Stroke is the leading cause of disability and the third leading cause of death in the United States. It is hoped that these statistics will change during the next decade as new treatments become available for reversing or halting the devastating effects of strokes. In June 1996 the Food and Drug Administration approved the first drug to treat ischemic strokes, which account for 70% to 80% of all strokes. This drug, called alteplase (Activase) or t-PA, is a tissue plasminogen activator that has been used in the treatment of heart attacks. This drug dissolves blood clots and restores blood flow to the tissue. Results of a 5-year clinical trial of more than 600 patients with strokes found that patients who received t-PA treatment within 3 hours of their initial symptoms were at least 30% more likely to recover from their stroke with little or no disability after 3 months. 1 Dangers of t-PA treatment include a slightly increased risk of brain hemorrhage, but overall the benefits far outweigh the risks. One major limitation of t-PA treatment is the need for the drug to be administered within 3 hours of the onset of symptoms. Thus to benefit from this major breakthrough in the treatment of strokes, patients and their families need to recognize the warning signs of stroke, and they need to seek immediate medical attention at a hospital that is prepared to evaluate and treat patients with strokes. This requires a major health education effort to reverse and correct the current perception that strokes and transient ischemic attacks are untreatable conditions that do not warrant emergency evaluation. Gerontologic nurses can play an important role in educating older adults and their families about the warning signs of stroke and the need for immediate evaluation (Box 1). A previous "Drug Consult" column provided guidelines for education about the prevention of strokes through lifestyle adaptations and medical interventions, a National Stroke Awareness Month in May is an ideal time to begin incorporating health care education about the prevention and treatment of strokes. Free health edu-
cation materials can be obtained from the National Institute of Neurological Disorders and Stroke at the National Institutes of Health, Bethesda, MD 20892. These materials are also available through the Internet at
htpp://www.ninds.nih, gov/healinfo/disorder/stroke/stroke ws.htm Free educational materials are also available from the National Stroke Association at (800) 787-6537 and the American Heart Association at (800) 242-8721. • REFERENCES 1. The National Institute of Neurological Disorders and Stroke tPA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1996;333:1581-7. 2. Miller CA. The nurses' role in preventing "brain attack." Geriatr Nurs 1994;15:227-8.
CAROL A. MILLER, RN-C, MSN, is a gerontologic nurse specialist with Care & Counseling, MillerAVetzler Associates, Cleveland, Ohio. Geriatr Nurs 1997;18:131. Copyright © 1997 by Mosby-Year Book, Inc. 0197-4572/97/$5.00 + 0 34/1/81374
GERIATRIC NURSING Volume 18, Number 3
Miller
131