NEW YORK (Reuters Health) - New research confirms that a very low dose of tissue plasminogen activator (tPA), a clot-busting drug, improves survival in patients with bleeding or "hemorrhagic" strokes, a type that is usually fatal.
"While it appears counterintuitive" to give clot-busting drug for a bleeding stroke, "it really is revolutionary," Dr. Daniel Hanley commented to Reuters Health.
The final results from the CLEAR IVH trial were reported Wednesday at the European Stroke Conference in Nice, France, by principal investigator Hanley of The Johns Hopkins University School of Medicine in Baltimore.
Accumulation of blood in brain cavities called ventricles is a big reason why bleeding strokes are so deadly, Hanley and colleagues note in meeting materials. Use of tPA at a very low dose may help remove the blood from the ventricles without raising the risk of further bleeding.
Initial results from the study, reported at the American Stroke Association's International Stroke Conference in 2006, showed that tPA at a dose of 1 milligram given every 12 hours for up to 4 days improved survival, without increasing the risk of further bleeding.
The final results, based on 52 patients, showed that the ventricular clots dissolved fastest when tPA was given every 8 hours instead.
At 30 days, the death rate in the full study group was 15 percent, which is much better than the 80 percent rate that is typically seen with bleeding strokes, Hanley noted.
"We think that this treatment is the most promising story in brain hemorrhage in many years," Hanley said in a statement issued by Johns Hopkins. "We've taken a condition that used to have an extremely high rate of death and disability and turned it around."
