Question 1

how effective is t-pa for a 90 year old suffering a stroke?

Accepted Answer

Might help: When thromboplastin activator first appeared it was felt dangerous for elderly pts, and only safe if used very early.  All of this is now modified and it may be both safe and effective in older pts if additional risk factors are not present.  However, still most effective if used as early as possible.

Question 2

how effective would t-pa be for a 95 year old with a stroke?

Accepted Answer

Opinion: You may find a variable amount of opinions but from a neurosurgeons perspective, the risk is too high to give tpa (alteplase) to a 95 year old with a stroke.  Someone needs to have a frank discussion with the family regarding proper treatment for patients of a certain age.  The tpa (alteplase) may work great, but the risks of hemorrhage or other life threatening complications is high.

Question 3

what is tpa, (alteplase) and why is it important in stroke?

Accepted Answer

It dissolves clots.: Tpa (alteplase) stands for tissue plasminogen activator. As its name implies, it activates plasminogen which is essentially a blood clot buster. If a stroke results from a clot occluding blood flow to the brain tissue, as is the case for an ischemic stroke (embolic or thrombotic in nature) tpa (alteplase) can be helpful in dissolving the clot and restoring blood flow.

Question 4

what % of ischemic mca stroke patients benefit from tpa (alteplase)?

Accepted Answer

Depends: This is a complex question.  It depends on what percent of is already showing signs of infarction (dead brain) rather than just ischemia (brain at risk).... When we see > 1/3 of territory abnormal on initial ct scan, it is a contraindication for tpa (alteplase).  
It also depends on how long the symptoms have been occurring.
But to answer your question, theoretically all could potentially benefit.

Question 5

what may be negative effects of a stroke at home and missing the "golden hour"  by up to additional hour for iv-tpa to be given in the er, in many cases?

Accepted Answer

Stroke sequelae: May spread from minimal/ imperceptible through paralysis, speech and swallow partial or total loss of function to death depending on size and location and naming only a few.

Question 6

do lacunar strokes benefit more or less , than other ischemic stroke subtypes to tpa following recommendations and qualifications for tpa administration guidelines ?

Accepted Answer

: Lacunar strokes, a type of ischemic stroke, are small and located in non-cortical areas. Remember, most strokes are ischemic strokes. If tPA is used, the benefit is bigger for big ischemic area because most lacunar strokes are asymptomatic and this type of stroke is often incidentally detected when CT or MRI is done.

Question 7

why don't stroke patients get tpa (alteplase) therapy?

Accepted Answer

Patients wait: The most common reason is they wait too long before presenting to hospital. Current guidelines for t-pa in most hospitals have been extended from 3to 4.5->5 hours after the onset of symptoms of a stroke. Part of the problem is many patients wake up with weakness/speech difficulties, the time of onset can't be determined, the patient is ineligible.Recent major surgery or bleeding are exclusions.

Question 8

could you tell me what happens if a person who is not actually having a stroke is given tpa (alteplase)?

Accepted Answer

Increased bleed risk: Tissue plasminogen activator, or tpa, (alteplase) "dissolves" clots, so the main risk from it's administration is an increased risk of bleeding.  One way to reduce the risk is to have strict rules on who it is administered to, based on many factors including time since symptoms began.  Another is to administer it right where it is needed, near the location of the artery which contains the clot.

Question 9

2 years ago all tests say i didn't have a stroke. administered tpa (alteplase) and improved. why did i respond to a drug for something tests say i didn't have?

Accepted Answer

Question: So if you didn't have a stroke what improved when you got the TPA (alteplase)?

Question 10

in general, the odds that moderate to severe stroke symtoms may be eliminated by iv-tpa, alteplase when given within the "golden hour"- from onset to injection? or,  mainly effective for mini strokes?

Accepted Answer

Valuable : TPa works best the earlier given, best by 3-4 hrs but now often given later.  Arterial route also of value.  We use it for any stroke large or small if safe to do

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Doctor answers about:

Tpa dosing for stroke

A member asked:

How effective is t-pa for a 90 year old suffering a stroke?

A member asked:

How effective would t-pa be for a 95 year old with a stroke?

A member asked:

What is tpa, (alteplase) and why is it important in stroke?

A member asked:

What % of ischemic mca stroke patients benefit from tpa (alteplase)?

A member asked:

What may be negative effects of a stroke at home and missing the "golden hour" by up to additional hour for iv-tpa to be given in the er, in many cases?

A member asked:

Do lacunar strokes benefit more or less , than other ischemic stroke subtypes to tpa following recommendations and qualifications for tpa administration guidelines ?

A member asked:

Why don't stroke patients get tpa (alteplase) therapy?

A member asked:

Could you tell me what happens if a person who is not actually having a stroke is given tpa (alteplase)?

A member asked:

2 years ago all tests say i didn't have a stroke. administered tpa (alteplase) and improved. why did i respond to a drug for something tests say i didn't have?

A member asked:

In general, the odds that moderate to severe stroke symtoms may be eliminated by iv-tpa, alteplase when given within the "golden hour"- from onset to injection? or, mainly effective for mini strokes?

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