by A recent study has found that faster treatment for brain hemorrhages, the deadliest type of stroke, is associated with a greater likelihood of survival. Brain hemorrhages occur when a weakened blood vessel in the brain ruptures and causes bleeding. Approximately 20% of patients who experience brain hemorrhages are taking anticoagulant medications, which increase the risk of or worsen brain bleeds. Anticoagulants, such as warfarin, rivaroxaban, dabigatran, and apixaban, are commonly used to treat cardiovascular conditions like atrial fibrillation and blood clotting disorders.
Although anticoagulants are important and effective medications, it is crucial to be aware of the rare but serious risk they pose to individuals. Kevin Sheth, MD, a professor of neurology and neurosurgery, emphasizes the need for health systems to be prepared to respond swiftly in case of emergencies.
In recent years, reversal agents for anticoagulants have been developed and can be administered in hospital emergency departments to save lives. However, the timing of these treatments has been a topic of discussion among experts. The current study, using a large dataset, demonstrates that administering reversal treatments more quickly can increase a patient’s chance of survival. The findings were published in JAMA Neurology.
There are two main types of strokes: bleeding (brain hemorrhages) and clotting. Clotting strokes occur when clots block blood flow to the brain. In 1995, the U.S. Food and Drug Administration (FDA) approved tissue-type plasminogen activator (tPA), a clot-busting agent, for ischemic strokes. Research showed that earlier tPA treatment within four and a half hours led to better health outcomes.
Sheth’s study, conducted in collaboration with the American Heart Association’s Get With The Guidelines stroke registry, identified patients who had suffered a brain hemorrhage while taking anticoagulants and had received anticoagulant reversal agents. The researchers observed the time between patients’ arrival at the emergency department and the delivery of treatment.
The analysis revealed that patients who received the reversal agent within an hour of arrival had the highest likelihood of survival. This finding confirms the importance of timing in brain hemorrhage emergencies. Additionally, the study found significant disparities in wait times, with white patients experiencing shorter wait times than Black patients. Sheth highlights the opportunity to improve both overall survival rates for brain hemorrhages and to address health disparities.
The study provides evidence that brain hemorrhages require urgent treatment, with every minute countings. Sheth notes that prior to this study, the urgency associated with brain hemorrhages was not well understood, resulting in delayed treatment compared to clotting strokes. The findings will inform efforts to improve the quality of care and expedite treatment for brain hemorrhages.
Sheth’s team plans to continue working with the American Heart Association to analyze factors contributing to longer wait times for treatment. They also aim to develop initiatives to help patients receive rapid and timely care. By prioritizing swift treatment for brain hemorrhages, lives can be saved and health disparities can be addressed.
