Heart drug busts brain clots from stroke.

A clot-busting drug commonly used to treat heart attacks also curtails brain damage caused by the most prevalent type of stroke.

A collaborative study of people who suffered strokes caused by blood clots in the brain indicates that patients treated with tissue plasminogen activator (t-PA) were 30 percent more likely to make excellent recoveries than patients given a placebo.

"This is a real breakthrough," says John R. Marler of the National Institute of Neurological Disorders and Stroke in Bethesda, Md., which funded and coordinated the work. "It is the first time a drug has shown a clear benefit in treating acute stroke."

Marler notes that the researchers also confirmed suspicions that t-PA increases a person's risk of having a serious brain hemorrhage. Even so, approximately the same number of patients died in each group. Moreover, fewer patients treated with t-PA sustained permanent disability.

Approximately 500,000 people in the United States suffer strokes annually. Ischemic strokes, which result when a blood clot reduces blood flow to the brain, constitute 80 percent of these cases. The rest-known as hemorrhagic strokes-are caused by bleeding in the brain.

The trial, conducted by researchers across the United States, included 624 patients who received either intravenous t-PA or a placebo within 3 hours of initial stroke symptoms. Before giving either treatment, researchers used very fast computerized tomography to confirm that the patient was having an ischemic stroke.

As reported in the Dec. 14 New England Journal of Medicine, patients treated with t-PA faced less disability after 3 months than those given the placebo. Hemorrhaging in the brain occurred in 6.9 percent of the patients on t-PA but in only 0.6 percent of those taking the placebo.

Stroke researchers are excited, despite the treatment's risk of hemorrhage. "This is the first stroke treatment which has withstood the crucible of scientific investigation," says Charles H. Tegeler of Wake Forest University's Bowman Gray School of Medicine in Winston-Salem, N.C. J.P. Mohr of Columbia University's College of Physicians and Surgeons notes that "this finding is the first of hopefully many that will change the public attitude from 'nothing to be done' to 'everything to be done.'"

While the findings impress Cathy A. Sila of the Cleveland Clinic Foundation, she emphasizes that "it is amazing that the researchers mobilized the community to recognize the symptoms of stroke and get [the patient] to the hospital." Strokes are often painless, but warning signs include sudden weakness or numbness, loss of vision, severe headache or dizziness, and difficulty in moving-symptoms the victims themselves often don't recognize.

Marler notes the need for further research and training before this treatment becomes the standard of care.