Stoke Prevention Guidelines for women have just been issued by the American Heart Association / American Stroke Association (AHA/ASA) to reduce their risk of stroke. The issue of how men and women differ in their stroke risks has long been discussed so these guidelines are welcomed. The stroke prevention guidelines were published in a recent issue of Stroke and set forth methodology to determine a stroke risk score specifically for women. Each year, there are 55,000 more strokes in women than men. While stroke is the 5th leading cause of death in men, it is the 3rd leading cause of death in women. The guidelines point out that it critical to identify women at risk for stroke and to implement preventive care.
Treatment of recent lacunar stroke with aspirin alone compared with aspirin and Plavix shows that aspirin is as effective as using both together. More importantly, aspirin alone caused fewer major hemorrhages and death. A recent study in the New England Journal of Medicine investigate treatment of patients who suffered acute lacunar strokes. These brain infarcts result from occlusion of one of the arteries that penetrate into the deep brain structures and can result in typical symptoms as well as ataxia (incoordinated muscular movements), dysarthria (difficulty saying words) and clumsiness of the hand especially when writing.
The use of intravenous recombinant tissue plaminogen (rt-PA) to treat stroke was initially restricted to treatment in patients under the age of 80 and when started within 3 hours of symptom onset. Treatment with rt-PA can cause lysis of intravascular clots that cause brain ischemia and restore blood flow to affected areas before permanent injury results. The window for treatment was then extended to 4.5 hours after symptom onset, but its use was still restricted to patient less than 80 years of age.
The FDA approved intravenous tissue plasminogen activator (tPA) for the treatment of patients with acute ischemic stroke more than 15 years ago. Dr. Mark Alberts writes in the current Journal of the American Medical Association (JAMA) that even though tPA is the only acute medical therapy proven to reduce disability and improve outcomes in these patients, it still remains vastly underutilized as a treatment. Many patients who should be treated with intravenous tPA do not receive it for reasons that are unclear, subjective or simply incorrect. Failure to treat strokes with tPA causes avoidable injury.