Who might receive tPA?
Someone who has experienced a stroke may be eligible for treatment with tPA if they have had a blocked-vessel stroke and if treatment can be started within 3 hours of when stroke symptoms first appeared. tPA works on all kinds of blocked-vessel stroke, including strokes in large arteries, small arteries, and strokes caused by blood clots that traveled from the heart (embolic stroke).15
You should not receive tPA if:
- You suffered a bleeding (hemorrhagic) stroke – tPA can make the bleeding worse
- You suffered a TIA and the neurologic symptoms are going away on their own
- You have had head trauma or a stroke or heart attack in the last 3 months
- You have had bleeding in the digestive tract or urinary tract in the last 3 weeks
- You have had major surgery in the last 2 weeks
- You have a history of bleeding in the brain
- You have repeated measurements of very high blood pressure (more than 185/110) that can't be controlled before treatment with tPA
- You are taking a blood thinning drug (such as warfarin or aspirin) and your INR (a measure of the stickiness of your blood) is more than 1.7
- Your blood sugar level is lower than 50 mg/dL
In the past, patients who had a seizure that accompanied their stroke could not receive tPA. Now people who suffer seizures with a stroke may be eligible for treatment as long as the doctor is convinced that any problems that remain are due to the stroke, and not caused by the seizure.16
There had also been concern that women treated with tPA who were actively menstruating might experience increased bleeding, but available evidence indicates that the benefits outweigh the risks and treatment with tPA should not be denied or delayed for women who are menstruating.17
Are women less likely than men to receive tPA?
Some studies suggest that women who are eligible for tPA treatment are less likely to receive it than their male counterparts. This is in line with studies that find that women are less likely than men to receive many life-saving tests and treatments for stroke. For example, researchers observed all stroke patients in Michigan hospitals over a 6-month period (2566 people, 53% were women) and found that women were half as likely as men to receive tPA.18 An analysis of over 23,000 patients from 137 community hospitals found that women were 16% less likely than men to receive tPA, although this difference was small enough to be due to chance.9 Other studies have found that women and men are equally likely to get tPA.11 The fact remains that the most important factor in deciding whether you receive tPA—for both women and men—is how quickly you seek treatment.