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Thrombolysis Therapy In Stroke Treatment

The World Health Organization recent statistics stated that almost 15 million people suffer stroke worldwide each year. In which, 6.2 million dies and another 5 million are permanently disabled. Your brain loses an estimated 1.9 million cells in each minute when you encounter a stroke. Each hour a stroke goes untreated your brain ages which is equivalent of three and a half years. The longer a patient doesn’t receive treatment for the stroke, the greater chance of lingering memory loss, behavioral changes or speech difficulties.


Stroke has already reached epidemic proportions. Current trends suggest that the number of annual deaths will climb to 8 million by 2020 without appropriate action. Stroke claims a life every 6 seconds. It is the second leading cause of death for people above the age of 60 and it affects children as well. Stroke is responsible for more deaths annually than the combined count of AIDS, malaria and tuberculosis. Stroke patients (together with dementia) account for almost one third of all long-term disabilities worldwide. Those stats are even more awful when you realize that 75 per cent of strokes are preventable and that advancements in treatment have improved the odds of recovery. The earlier a stroke is fixed, the better the treatment options, which can decrease damage and improve the odds of a complete recovery.


What is a stroke?

A stroke occurs when the supply of blood to the brain is either reduced or interrupted. When this happens, the brain does not get enough oxygen or nutrients, and brain cells start to die within minutes.
Main types of stroke are ischemic stroke and hemorrhagic stroke. It’s estimated that about 87 per cent of strokes are ischemic strokes. Since ischemic and hemorrhagic strokes have different causes, both need different types of treatment.

Ischemic stroke

Ischemic strokes are caused by arteries being narrowed or blocked and so treatment focuses on reinstating a sufficient flow of blood to the brain. The stroke model is similar to that of a heart attack. The blood clot is frequently due to atherosclerosis, which is an accumulation of fatty deposits on the inner lining of a blood vessel. A portion of these fatty deposits can detach and block blood flow in the brain.

 

Hemorrhagic stroke

Hemorrhagic stroke is caused when a weakened blood vessel in the brain ruptures or breaks, spilling blood into the surrounding tissues which compress the surrounding brain tissue. The treatment focuses on controlling the bleeding and reducing the pressure on the brain.

 

Treatments for stroke:

The treatment depends on what type of stroke the patient is diagnosed with. In any case, the person must get to a hospital immediately for the treatments to work. Ischemic stroke treatments can be divided into emergency treatments to reverse a blockage and preventive treatments to prevent further occurrence of stroke. Hemorrhagic stroke treatment focuses on stopping the bleeding.


Thrombolytic therapy

Thrombolysis (AKA thrombolytic therapy) is a treatment to dissolve dangerous clots in blood vessels. The stroke patients are treated with a clot-busting drug to disperse the clot to improve blood flow to brain as well as prevent damage to tissues and organs. The effectiveness of thrombolytic drugs depends on two important factors:

  • The age of the clot can reduce the efficiency of the thrombolytics. For e.g., older clots tend to have more fibrin crosslinking and are more resistant to thrombolytics
  • The specificity of the lytic for fibrin will determine its activity, and other determinants of efficacy include half-life and the presence of any neutralizing antibodies.

Thrombolytics can be divided into two different categories:

  • fibrin-specific thrombolytics
  • nonfibrin-specific thrombolytics

Some examples of fibrin-specific drugs are: alteplase, tenecteplase, reteplase etc. Nonfibrin-specific drugs include staphylokinase or streptokinase. Alternatively, lytics that convert plasminogen into plasmin can be described as direct versus indirect. Direct activators are the same as those previously listed for fibrin-specific drugs. Indirect activators of plasminogen include streptokinase, staphylokinase and desmoteplase (vampire bat plasminogen activator). 


It’s important to get to hospital as quickly as possible when the stroke symptoms start. The sooner you are treated, the lower the risk of harm and better the chances of improvement.


Emergency management of stroke

IV Thrombolysis:

IV-thrombolysis for ischemic stroke began its extensive adoption in the late 1990s after the publication of the National Institute of Neurological Disorders and Stroke study. The Thrombolytic “clot-buster” drugs will be delivered through a peripheral intravenous (IV) line; typically through a visible vein in the arm. The most widely used “clot-buster” drug is tissue plasminogen activator (tPA). After the stroke attack, the tPA should be given as quickly as possible to be effective.


IA Thrombolysis(IAT):

IAT may be used in addition to intravenous tissue plasminogen activator (tPA) or in patients who do not qualify for tPA, usually because they are outside the approved stroke timeframe window or have contraindications, such as elevated international normalized ratio or partial thromboplastin time(These are used to determine the clotting tendency of blood). The tPA drug can be delivered right at the clot site using a very small catheter and the drug does not have to travel through your entire body.


Recanalization (the process of restoring flow) rates correlate with clinical improvement, and with the newest catheters it is possible to achieve recanalization in roughly 75% of patients treated. IAT is beneficial for patients with large artery occlusions in the basilar, proximal middle cerebral or distal carotid arteries.


Mechanical Thrombolysis:

Large blood clots that block large arteries feeding the brain may not open fast enough with tPA. Mechanical treatments include the use of catheters to directly deliver a clot-disrupting or retrieval device to a thromboembolus that is occluding a cerebral artery. The recent “thrombectomy devices,” are designed to grab the clot that is blocking the artery and pull it. 


These mechanical thrombolytic devices can remove a clot in a matter of minutes, whereas pharmaceutical thrombolytics, even those delivered intra-arterially, may take as long as 2 hours to dissolve a thrombus. Initially Microcatheter- and wire-based mechanical thrombectomy was used for clot disruption. An aspiration catheter which is used recently is like a vacuum cleaner that is attached to a special suction unit and used to suck out the clot. The most recently developed devices, known as stent retrievers or stentrievers, have shown better revascularization of cerebral vessels in acute stroke.

Who can have thrombolysis therapy?


People with certain health problems have increased risks with thrombolytic therapy. Therefore, a detailed health history must be taken to make sure whether it is safe to have the treatment.

Generally, thrombolytics may not be given to the persons, if they:

  • Had a recent head injury
  • Do not know or cannot tell doctors when the symptoms began
  • Had bleeding problems and bleeding ulcer
  • Had recent surgery
  • Had taken blood thinning medicines such as Coumadin
  • Had uncontrolled (severe) high blood pressure

Dr.Vanchilingam Hospital is one of the most distinguished speciality neurology hospitals with a dedicated team of experienced and skilled physicians, nurses and healthcare professionals led by founder, Dr.Vanchilingam. Dr.Vanchilingam hospital is the first and only single speciality hospital for neurology with a neuro ICU and the first hospital in the district to have an MRI scanner and a cath lab. Stroke recovery treatments in Tamil Nadu provided by Dr.Vanchilingam Hospital is the best for all the stroke-related issues. With a service that has spanned almost twenty years of expertise in treating patients from all around India and overseas, the centre has grown into a distinguished speciality neurology hospital and best center for Stroke treatment in Thanjavur. They are also famous in thrombolytic therapy in Tamil Nadu for blood clot treatment in India.

 

 

Mail Us : info@drvanchilingamhospital.com

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