Tissue plasminogen activator, or TPA, is a medicine that dissolves blood clots fast. Most strokes are caused by a blood clot. This kind of stroke is called an ischemic (say "iss-KEE-mick") stroke. For an ischemic stroke, TPA can dissolve the clot quickly and help blood to flow normally again. This can help limit damage to the brain.
TPA is given through a vein in your hand or arm. It travels through the bloodstream to the clot. This treatment is most often done in the hospital.
Doctors try to give TPA within 3 hours after stroke symptoms start. Some people may be helped if they are able to get this medicine within 4½ hours of their first symptoms.
When a blood clot moves to a blood vessel in the brain, it blocks blood flow to that area and causes a stroke. Without blood and the oxygen it carries, that part of the brain starts to die. If blood supply isn't restored, permanent damage usually occurs. The body parts controlled by those damaged cells can't work, or function, as they should. This loss of function may be mild or severe. It may be short-term or lifelong.
Treatment with TPA can improve recovery from a stroke, especially if it's given as soon as possible after the stroke happens. It can limit brain damage from a stroke by dissolving the blood clot. Without TPA to dissolve it, a blood clot in your brain is more likely to cause serious brain damage.
In general, the less damage there is to the brain tissue, the less disability a stroke causes. And with less damage to brain tissue, you are more likely to recover from the stroke.
No treatment can guarantee a full recovery from a stroke. But TPA does improve your chances of having less or no disability after a stroke.
The main risk of TPA is that it can cause serious bleeding in the body. If bleeding happens in the brain, it can cause worse stroke symptoms or even death.
Doctors are very careful about using TPA. For example, a brain scan is done before TPA treatment to make sure you have no signs of bleeding. (Treatment with TPA would make any bleeding worse.) And after treatment, you are closely watched for some time to make sure you have no internal bleeding.
When your doctor tells you that TPA treatment is a choice for you, it's because he or she believes that TPA offers you the best chance of recovery from stroke. But because TPA also has risks, it is up to you to choose it or not.
Based on your condition, your doctor will explain what other choices you have for treatment. They may include other medicines that stop the clot from getting bigger.
With or without TPA treatment, you will have care to help you get better. And you'll have medicine to prevent blood clots and control symptoms.
Having a stroke can make it hard to make quick and complex decisions. Feeling afraid or anxious can make it even harder to think clearly. Your hospital staff understands this. They will explain your choices, answer your questions, and help you decide about your treatment.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
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Current as of: December 6, 2017
E. Gregory Thompson, MD - Internal Medicine
& Martin J. Gabica, MD - Family Medicine & Adam Husney, MD - Family Medicine & Brian Leber, MDCM, FRCPC - Hematology & Colin H. Chalk, MD, CM, FRCPC - Neurology
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