Thrombolysis, sometimes referred to as clot busting, is the breakdown of blood clots. Based on clinical trial evidence, the usage of thrombolytic medications in stroke is typically restricted to patients who present to a healthcare facility within the first 3 hours of stroke onset.

However, according to a study published in the March 2009 issue of Stroke, some patients who wake up with symptoms suspicious for stroke may still benefit from thrombolysis .

Patients who wake up with stroke symptoms are usually excluded from thrombolytic therapy because the time of stroke onset cannot be reliably determined. Researchers from the University of Texas-Houston evaluated off-label usage of thrombolysis in 46 patients who woke up with stroke. They found that these patients had higher rates of excellent and favorable outcome compared to 34 patients who woke up with stroke but were not treated with thrombolytics. However, these patients did demonstrate a higher rate of mortality. The researchers also compared the outcomes of these wake-up stroke patients with the outcomes of 174 stroke patients who received thrombolytic therapy within 3 hours of symptoms and found no significant differences in safety and clinical outcomes.

Approximately one-quarter of stroke patients wake up with stroke symptoms. The results of this small study suggest that thrombolytic therapy may be safe for these wake-up stroke patients, but a large prospective, randomized trial is need to confirm these findings.

Source

Stroke. 2009;40:827-832.