Stroke treatment: lysis therapy within 4.5 hours
In Germany, over a quarter of a million people suffer a stroke. It is crucial for successful treatment that patients are treated as quickly as possible on a so-called stroke unit. A new study now confirms that the lysis therapy must be given within 4.5 hours after the stroke.
Effective even for older people Every year over a quarter million people in Germany suffer a stroke. After a brain attack, it has to be done quickly. As reported by representatives of the German Stroke Society (DSG) and the German Society for Neurology (DGN), a new study shows that the earlier the so-called lysis therapy is started, the better the treatment results for the patient. In lysis therapy, blood clots in the cerebral artery are dissolved by infusion with the enzyme Alteplase. The results of the meta-analysis of nine major therapy studies were recently published in "The Lancet". The study confirmed that lysis treatment is effective 4.5 hours after the stroke, even in the elderly.
Best results with treatment within three hours The results are best when treatment begins within the first three hours. In addition, a patient's chances of surviving the stroke without severe disabilities were 75 percent higher than in the control group who did not receive lysis therapy. If lysis was started three to 4.5 hours after the stroke, the benefit was still 26 percent. "Our results confirm the effect of the lysis in the time window of 4.5 hours," said Professor Werner Hacke from the Heidelberg University Clinic. At a later point in time, however, their use will always be an individual decision. Hacke is the head of the “Stroke Thrombolysis Trialists’ Collaborative Group ”, which carried out the meta-analysis. For the analysis, the international team of researchers evaluated data from all 6,756 study participants individually in order to obtain the most genuine picture of the effectiveness and possible risks.
Doctors are cautious in older patients with lysis therapy The German Stroke Society (DSG) also considers the new results to be important because many doctors, especially in older patients, are still reluctant to use lysis therapy. "The fear of complications is widespread," said Professor Joachim Röther, spokesman for the DSG and chief physician of the neurological clinic at Asklepios Klinik Altona. Since around a quarter of the test subjects were older than 80 years, the current meta-analysis provides reliable results for the first time. "The success rate of lysis therapy was by no means worse for the very old, and the results tended to be even better," said Röther. The expert also sees no problems with regard to the risk of bleeding in older patients.
Stroke is "always an emergency" Since bleeding is the most feared complication of lysis therapy, the German Society for Neurology points out that the resolution of the blood clot should always be preceded by computer or magnetic resonance imaging in order to rule out cerebral bleeding as the cause of the stroke. "Although the examination delays the start of therapy, a well-organized stroke unit with appropriately qualified staff can compensate for this," said DGN press spokesman Professor Hans-Christoph Diener. In addition, the education of the population is important. "Relatives need to know that a stroke is always an emergency, even if the person is not in pain." The symptoms that can be signs of a stroke include numbness, tingling, speech and vision disorders, gait insecurity or suddenly occurring A headache. According to experts, the main risk factor for a stroke is high blood pressure. Therefore, people are always advised to live healthier, for example through more exercise, weight loss, better nutrition and not smoking.
Effectiveness proven for 20 years "The effectiveness of lysis therapy was first demonstrated in a clinical study almost 20 years ago, and lysis has now become firmly established on all certified stroke units in Germany," explained Professor Dr. med. Hans-Christoph Diener, Director of the Clinic for Neurology at Essen University Hospital. Nevertheless, it is only carried out in around ten percent of stroke patients in Germany. "This is mainly due to the fact that only about 30 to 40 percent of stroke patients reach the clinic in time," said the expert. In some European countries, this treatment is not recommended for mild or particularly severe strokes, as well as for people over 80 years of age. This does not apply to Germany. (ad)
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