A banner to promote use of (tPA) tissue plasminogen activator
Posted in Best practices/emergency care For the general public

Do you know about the clot-busting drug?

Yes, whenever a person suspected of having a stroke reaches a hospital with stroke care facilities within four and a half hours of the event – that is from the last known normal – he or she should have the clot-busting drug. This is the 2018 recommendation by the American Heart Association/American Stroke Association.

What is this clot-busting drug?

This drug is called “tissue plasminogen activator” (tpa); however, there is a catch: its benefits are time-dependent; earlier the better. Ideally, it should be within the four and a half hours from the “last known normal“. Before administering this medication, they recommend someone to have two tests: a non-contrast CT scan and a random blood glucose test. The CT scan is necessary to determine whether the attack is either due to a blockage to the supply route or due to bleeding. If it is due to bleeding, this drug is not recommended.

This finding was first discovered 24 years before and The New England Journal of Medicine journal published the study in 1995. However, even after this prestigious college’s endorsement, some emergency physicians seem to be reluctant moving forward with the practice. Recently, Gina Kolata elaborated experts’ arguments for and against this practice in an article written to The New York Times.

chase the golden hour
Posted in Best practices/emergency care For the general public

What does the “golden hour” mean in stroke care?

Imagine the following trail of events: you start to observe one or more F.A.S.T. stroke symptoms and signs in a person; you call an ambulance; emergency responders arrive at the scene; they determine of a stroke; they rush the person to a stroke unit; the person is treated with a blot clot-dissolving medication.  If all these events occur within the first hour from the time of detection, that is the golden hour.

This is because of every passing second matter. Ans this is why we call, “Time is Brain”. Read about it more on the “Journeys to the Brain” series.

Time is the critical factor; 32,000 neurons die ever passing second as Jeffrey L. Savers wrote in 2005.

Why this hour is golden? 

A group of Scandinavian researchers (Advani et al. 2017) have shown that irrespective of age and pre-existing disease conditions, those who were treated within this golden hour reached excellent outcomes. This is a very significant finding because age (how much old an individual is) should not be considered as a factor to call for an ambulance and to intervene at the hospital. 

Not only they, but other researchers have also demonstrated the importance of this hour.

However, passing this golden hour does not mean that we should lose our hope of salvaging the affected brain tissues. The Canadian best practice guidelines advocate the onset-to-needle time as “four and a half hours” (page 3) from the onset of symptoms. 


Advani R, Naess H. & Kurz M.W. (2017). The golden hour of acute ischemic stroke. Scand J Trauma Resusc Emerg Med. 2017 May 22;25(1):54. doi: 10.1186/s13049-017-0398-5.