How tissue plasminogen activator (tPA) works in stroke


Tissue plasminogen activator, or tPA, is the only drug approved by the FDA for the treatment of ischemic or thrombotic stroke , which is a stroke caused by a blood clot interrupting blood flow to a specific area of the brain .

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It has also been used in the treatment of pulmonary embolism and myocardial infarction . TPA is an anticoagulant and therefore is not used for hemorrhagic strokes or head injuries.

How does it work

TPA is a natural protein found in endothelial cells, the cells that line blood vessels. It activates the conversion of plasminogen to plasmin, an enzyme that breaks down clots and helps restore blood flow to the brain. It is a powerful drug that must be taken by an experienced medical team.

Before treatment with tPA

You should expect to have a computed tomography (CT) scan of your brain before treatment with tPA. This is because there are several medical conditions that make obtaining tPA too dangerous for you. If you have any of these conditions, not only will tPA not help you, it can cause significant harm to your health.

Conditions that make you eligible for tPA treatment include :

  • Hemorrhagic stroke (brain hemorrhage)
  • Brain aneurysm or AVM
  • Recent surgical procedure
  • Head injury
  • Bleeding or blood clotting disorders.
  • Bleeding ulcers
  • The pregnancy
  • Anticoagulant medications
  • Injury
  • Uncontrolled high blood pressure

TPA administration

Treatment with TPA was effective for people with ischemic stroke when given intravenously within 4.5 hours of the onset of symptoms. Endovascular treatment to remove the clot or administer tPA to the clot site is considered within 24 hours of the stroke.

The Acute Stroke Treatment Guidelines published by the American Heart Association in 2018 strongly recommends that eligible patients receive alteplase (tPA) within 4.5 hours of the onset of stroke symptoms. This treatment approach has been shown to produce the best overall results.

Protocols have been developed to quickly determine if you are likely to have a stroke so that your examination and treatment can be quick and effective, allowing you to receive life-saving treatment in a timely manner. In fact, some centers are making progress in stroke diagnosis earlier than ever with mobile stroke units .

Side effects

Although tPA has been shown to be helpful in treating stroke, there is a risk associated with tPA treatment, even for people who have been medically approved for tPA. It is a powerful blood thinner, so serious side effects can occur, including the following:

  • Hemorrhage (bleeding) in the brain – causes headaches, weakness, confusion, loss of consciousness, seizures.
  • Bleeding in the digestive system: causes blood in the stool or stomach pain.
  • Severe blood loss: causes dizziness, low blood pressure, loss of consciousness.
  • Mild bleeding from the gums or nose.
  • Blood in the urine

If you experience any of these side effects, you should inform your healthcare team immediately.

Recognize stroke symptoms

The best way to maximize your chances of getting the most effective stroke treatment is to go to the emergency room as soon as possible. A person with a stroke may not be aware of the symptoms. You can learn to recognize a stroke and get help right away.

Don't wait for symptoms to go away. The sooner the stroke is cured, the less long-term consequences will be.

Symptoms of a stroke include:

  • Difficulty understanding words or speaking.
  • Numbness in an arm, face, or leg
  • Blurred or darkened vision in one or both eyes
  • Double vision
  • Sudden severe headache
  • Threw up
  • Dizziness
  • Dificulty to walk
  • Loss of balance or coordination
  • Weakness in the face, arm, or leg
  • Droopy face or eyelid
  • Confusion

Get the word of drug information

Stroke prevention is an important part of a healthy lifestyle. Although treatment is increasingly effective in reducing the serious consequences of a stroke, prevention is the most effective way to avoid the consequences of a stroke.

Ways to control risk factors for stroke include:

  • Give up smoking
  • Slim down
  • Increased physical activity.
  • Cut down on alcohol
  • Elimination of illegal drug use
  • Reduce cholesterol and fat levels.
  • How to cope with diabetes, if you have it
  • Maintain a healthy blood pressure

If you or a loved one has had a stroke or received tPA to treat a stroke, expect to recover, which can take time.

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