“As these reversal treatments have been coming to the fore, experts have been wondering if earlier timing was better,” says Sheth, who was first author of the study. “This paper, for the first time, demonstrates that it is.”
There are two main types of strokes—bleeding (brain hemorrhages) and clotting. A clotting (ischemic) stroke occurs when clots block blood flow to the brain. In 1995, the U.S. Food and Drug Administration (FDA) approved the first clot-busting agent for ischemic strokes, named tissue-type plasminogen activator (tPA). Shortly after its approval, researchers learned that earlier tPA treatment—within four and a half hours—led to better health outcomes. “This insight changed stroke systems of care,” says Sheth. “We had to identify those suffering clotting strokes and get them to the hospital quickly.”
But for brain bleeds, says Sheth, “that paradigm has never been there.”
Earlier brain hemorrhage treatment resulted in better outcomes
Sheth’s recent publication is the result of a collaboration with the American Heart Association Get With The Guidelines® stroke registry, one of the largest stroke registries in the world. Within the registry, his team identified people who had suffered a brain hemorrhage, who were on blood thinners at the time of their hemorrhage, and who had received anticoagulant reversal agents. Then, for this cohort, they observed the time duration between the patients’ arrival to the emergency department and delivery of treatment. “There was a large distribution there,” says Sheth. “Some received the reversal agent quickly, while for others it was quite slow.”
Their analyses revealed that those who were treated quickly with a reversal agent showed the best outcomes. Patients who were treated within an hour of arrival to the emergency department had the greatest likelihood of survival. “There are popular phrases we have in neurology like, ‘time is brain,’ and ‘every minute counts,’” says Sheth. “These results are in line with these phrases, but for brain hemorrhages, they are being verified for the first time.”
