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NIH Experts Say Few Eligible Stroke Patients Receive Treatments That Save Lives And Reduce Disability

For release: Monday, May 15, 2000

The National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health, said today that few eligible stroke patients receive treatments that can significantly reduce disability and save lives.

Gerald D. Fischbach, MD, director of NINDS, said that nearly five years after a NINDS clinical trial found that clot busting treatments can reduce or even reverse the symptoms of ischemic stroke, the treatment's promise is unfulfilled. The vast majority of patients who might benefit from it do not receive it.

"Again and again we see in research studies that patients do not recognize symptoms as stroke and get to the hospital in time," Dr. Fischbach said. "This is a crisis of under-utilization that causes unnecessary disability and costs millions extra in health care costs."

Patients who suffer from ischemic strokes, those that cause blood clots in the brain, have the most potential of receiving treatments that can reduce deaths and disability. One of the most effective ischemic stroke treatments is tissue plasminogen activator (t-PA). Nearly five years ago, a NINDS clinical trial found that patients who received t-PA treatment within three hours of their initial stroke symptoms were at least 30 percent more likely than untreated patients to recover from their stroke with little or no disability after three months.

Currently, there is no official national estimate of the percentage of ischemic stroke patients who receive thrombolytic treatments. However, numerous research studies in individual communities have concluded that about 10 percent or less of eligible stroke patients receive t-PA or other treatments, primarily because they arrive at the hospital after the three-hour window has closed. For example, a Cleveland-area study* published in the March 1, 2000, issue of the Journal of the American Medical Association, found that "the rate of IV t-PA use among hospitals varied from 0 percent to 10.2 percent of stroke admissions."

"Two things need to happen in order to ensure that more stroke patients benefit from treatments that dissolve blood clots in the brain," said John R. Marler, MD, associate director for clinical trials at NINDS. "First, people at risk for stroke and the people around them must know the signs of stroke. Then, they must call 911 and get to a hospital quickly. The sooner they begin receiving treatment, the better their chances for a complete recovery."

The main symptoms of stroke are:

Sudden numbness or weakness of face, arm or leg -- especially on one side of the body

  • Sudden confusion or trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes
  • Sudden trouble walking, dizziness, loss of balance or coordination.
  • Sudden severe headache with no known cause

During Stroke Awareness Month in May, NINDS researchers encourage people at risk for stroke and their family members, friends and caregivers to learn the signs of stroke. In many cases, because stroke attacks the brain, a person experiencing stroke will not realize a stroke is occurring. But the people around them can recognize the symptoms and act fast. Candidates can receive certain stroke therapies only if they can verify the onset of their symptoms to within three hours of arriving at the hospital.

"Stroke is a condition that is easy to see," said Dr. Marler. "There are few other medical conditions that come on so suddenly and that are so noticeable to a bystander. Many people avoid stroke because they treat their high blood pressure and stop smoking. But of those who do have strokes, few receive treatment."

For more information on stroke, consumers can visit the NINDS web site at, or they can call 877-562-3434 to receive a brochure on stroke.

*Katzan,, "Use of Tissue-Type Plasminogen Activator for Acute Ischemic Stroke: The Cleveland Area Experience." JAMA, March 1, 2000. Vol 283, No. 9. Pp. 1151-1158.

Originally prepared by Paul Girolami and Marian Emr, NINDS Office of Communications and Public Liaison.

Last Modified August 7, 2009