THE PURPOSE OF THERAPY IS TO REMOVE THE BLOOD CLOT TO IMPROVE BLOOD CIRCULATION IN THE AFFECTED AREA OF THE BRAIN

An ischemic stroke is a brain damage caused by blockage of blood flow in the brain’ blood vessels. This condition may cause glucose and oxygen deprivation in the brain, consequently causing the death of nerve cells. Common risk factors are hypertension, diabetes, a high level of cholesterol, smoking and heart arrhythmias.

Time is a crucial factor in the management of a stroke. The sooner proper treatment is executed, the better a patient’s outcome. Within three to four-and-a-half hours from the onset of a stroke’s symptoms, a specific therapy, called thrombolysis, should be performed. According to recent studies, this is the “golden period” for acute stroke management.

Unfortunately, many are unaware of this principle, which has caused delayed treatment, resulting in severe disability and death. “Many people are still confused about what to do when their family members suffer a stroke, thus causing delayed treatment–not to mention Jakarta’s traffic congestion, which in many cases contributes to losing the golden period,” said Siloam Hospitals TB Simatupang neurologist dr. Peter Gunawan Ng.

How can we use this principle to help save the lives of those afflicted by ischemic strokes? Sebastian Partogi from J+ has interviewed Peter to gain a better comprehension of the issue. Here’s an excerpt from the interview, edited for clarity and length.

Why is the golden period crucial?

Only within the golden period can thrombolysis be given. The purpose of this therapy is to remove the blood clot, thus improving the blood circulation in the affected brain area and subsequently minimizing the neurological deficit. Thrombolysis can only be given intravenously. Beyond the stipulated time, this procedure should not be performed.

The golden period for acute stroke management with thrombolysis, i.e., three to four-and-a-half hours, has been enforced by guidelines from the American Heart Association and American Stroke Association.

One of the campaigns commonly used to increase people’s awareness about strokes is called FAST, an acronym for facial asymmetry, arm weakness and slurred speech means its time to call an emergency. If someone experiences these symptoms, they need to seek treatment at the nearest hospital as soon as possible. Thus, the person will not squander the golden period and thrombolysis can be performed.

What needs to done before thrombolytic treatment?

Some procedures need to be conducted upon a patient’s arrival at the emergency department. Ideally, the door-to-needle time, a medical term referring to the time taken from the moment a patient arrives in the ER until the beginning of thrombolysis, should be less than 60 minutes. It is very important to determine the exact time of symptom onset by an interview. After a physical examination by ER doctors and neurologist; laboratory tests as well as a computerized tomography scan should be done as soon as possible. The results will determine whether a patient has the indications or contraindications for thrombolytic treatment.

What are the contraindications?

Although thrombolysis is a recommended procedure for stroke patients, there are still indications and contraindications that need to be taken into consideration before performing the treatment. Thrombolysis is not suitable for a hemorrhagic stroke. It is only appropriate for an ischemic stroke, and within the golden period. Some contraindications are internal bleeding, severe trauma or recent major operations. Because of a higher risk of cerebral bleeding, that is also a contraindication for thrombolysis if the computerized tomography scan result shows massive brain damage. Thrombolysis is also not recommended for patient with bleeding tendencies.

Thrombolytic procedure and its benefits

The first step all physicians need to do is to determine the proper dosage, calculated based on a patient’s body weight. The medication will be given intravenously, which will take an hour.

During the procedure, a patient’s vital signs and neurological functions will be monitored closely in stroke unit or intensive care unit for the next 24 hours. In most cases, a significant improvement can be seen within few hours. Once the blood clot has dissolved, the oxygen and glucose supply to the brain will be better. The area of the brain that is in deficit for oxygen and glucose, called penumbra, will regain its function. As an example, those who were previously paralyzed will be able to move their feet again.

However, the speed of recovery will be varied depending on a patient’s age and general health, the location of stroke and the severity of brain damage.

If the patient is unable to do the thrombolytic treatment, are there any other treatments available?

To further improve their condition, a patient should undergo physiotherapy and manage their risk factors optimally, which means quitting smoking and keeping their blood pressure, glucose level and cholesterol level in the optimal range. To prevent a stroke’s recurrence, patients are generally recommended to take blood thinner medication regularly, as long as there are no contraindications. Last but not least, patients should improve their lifestyles, exercise regularly, drink alcohol in moderation and develop good sleeping habits.

Popular

What Indonesia can learn from the Iran–Israel war

Police seek to polish image with new video platform amid public distrust

Two arrested in North Sumatra for allegedly producing vape liquid laced with narcotics