Game-Changing Medication Gives Patients Hope

Susan Swan's stroke might have had a far different outcome without the availability of tissue plasminogen activator (tPA), a powerful clot-blusting drug that can stop and sometimes even reverse the effects of an ischemic stroke.

Rapid Evaluation, Drug Treatment Can Change Stroke's Course

When tissue plasminogen activator (tPA) hit the market nearly 20 years ago, the clot-busting drug was an absolute game-changer for acute ischemic stroke patients and the medical professionals treating them.

For some patients, tPA can completely change the course of their stroke, allowing for better outcomes and higher post-stroke quality of life.

"We suddenly went from a state where an ischemic stroke was always a devastating, incurable cause of disability to a world where, in the right circumstances, a patient can be completely cured," said Patrick D. Lyden, MD, director of the Cedar-Sinai Stroke Program. "There has been nothing in neurology as big as tPA for stroke, and arguably there are few things in the history of medicine that is as big as tPA for stroke."

Lyden, who also serves as the chair of the medical center's Department of Neurology, is one of the nation's foremost authorities on stroke care and tPA. He was a major contributor to the pivotal clinical trial which led to the Food and Drug Administration's 1996 approval of the drug, and continues to delve into research about its use.

Tissue plasminogen activator functions mainly by improving blood flow to the brain after an acute ischemic stroke, and must be injected into a major artery within four and a half hours of the onset of stroke symptoms. If that's done, tPA can actually reverse the symptoms of a stroke. If not, the consequences can be permanent and debilitating – including impairments to speech, vision, cognitive ability, behavior and movement.

Rapid evaluation and action were vital in getting yoga instructor Susan Swan, 71, back in the studio and on the mat after her June 2010 stroke.

"It was like there was a tornado in my brain," Swan said, describing the day she collapsed in the middle of teaching a yoga session at Larchmont Village studio in Los Angeles. "Everything was all over the place, and when I woke up, I realized something major had happened."

Although she doesn't remember much from that day, she does recall lying in an ambulance, racing west on Third Street toward Cedars-Sinai, where she was evaluated and a "Code Brain" called, triggering the rapid response of the medical center's stroke team.

Swan received tPA within 45 minutes of her arrival in the Emergency Department.

Swan now leads an active, energetic life. She continues to teach yoga in her private studio, volunteers to help other Cedars-Sinai stroke patients during their time in the Neuroscience Critical Care Unit and helps lead the medical center's aphasia support group for patients learning to speak again post-stroke.

Shlee Song, MD, associate director of the Stroke Program, said the change tPA has brought to how stroke treatment is approached is immeasurable.

Before tPA, she said, patients diagnosed in the emergency room with a stroke were sent home and often asked to come back the next day, because there was nothing else to be done. Operational changes, such as the shift to rapid-response teams focused on immediate evaluation and treatment, are an outcome of the medical community's recognition of the positive impact tPA could have on patients' lives, she said.

The Stroke Program at Cedars-Sinai is a Joint Commission-certified Comprehensive Stroke Center, the highest possible quality-of-care designation, and consistently earns the American Heart Association/American Stroke Association Get With the Guidelines Gold Plus and Target: Stroke Honor Roll awards.

"We have this competitiveness in our group in terms of getting faster ‘door-to-needle' times, and every week we look at and evaluate those numbers," Song said. "The extraordinary collaboration between the emergency room and stroke teams has allowed us to achieve faster and faster times – sometimes even administering tPA within 30 minutes."

That's life-changing, said Lyden.

"We're talking about a cure – something that actually makes the stroke go away and often leaves the patient without any disability whatsoever," he said. "The success of tPA is frequent and the proportion of people who benefit is huge."

Although Swan still works to overcome some lingering effects of her 2010 stroke, she says doesn't even like to think about how much worse the outcome would have been had she not received tPA so rapidly.

Her evaluation of the clot-buster is simple: "The proof is in the pudding."

Thanks to the immediate response and treatment by Cedars-Sinai Stroke Program experts, 71-year-old yoga instructor Susan Swan is back on the mat and living the life she loves.