Question

The only FDA approved treatment for ischemic strokes is tissue plasminogen activator* (tPA, also known as IV rtPA, given through an IV in the arm). tPA works by dissolving the clot and improving blood flow to the part of the brain being deprived of blood flow. If administered within 3 hours (and up to 4.5 hours in certain eligible patients), tPA may improve the chances of recovering from a stroke. A significant number of stroke victims don’t get to the hospital in time for tPA treatment.

*Tissue plasminogen activator (abbreviated tPA) is a protein involved in the breakdown of blood clots. It is a serine protease found on endothelial cells, the cells that line the blood vessels. As an enzyme, it catalyzes the conversion of plasminogen to plasmin, the major enzyme responsible for clot breakdown. Because it works on the clotting system, tPA (such as alteplase, reteplase, and tenecteplase) is used in clinical medicine to treat embolic or thrombotic stroke.

Question: How would you suggest changing the drug and what techniques would you use to increase its efficacy?

Answer 1

We can either go for mechanical clot removal or we can change the drug as follows-

Long term treatment include Aspirin or an anticoagulant to prevent further clot.

If it is caused by conditions such as high blood pressure or atherosclerosis, then we can go for treatment to treat those conditions such as stent to open an artery narrowed by plaque Or statins to lower blood pressure

We can improve efficacy by restoring blood flow to the compromised area and optimising Collateral flow.