Treating mild strokes with the blood-clot dissolving drug approved for severe strokes could save $200 million in annual disability costs and lower the number of patients left disabled after suffering strokes, a new study finds.

Strokes can be caused by a blood clot (ischemic) or a ruptured blood vessel (hemorrhagic) preventing proper blood and oxygen flow to the brain. The majority –about 87%– are ischemic, according to the American Stroke Association.

Tissue plasminogen activator (tPA) is the only drug approved by the FDA for treating ischemic stroke. It dissolves blood clots and, when given within 4.5 hours of the onset of symptoms, can prevent permanent disability in patients. But tPA can cause brain bleeding when given too late. While tPA is often used to treat moderate to severe strokes, its use for treating mild strokes is unproven, according to information provided by the American Stroke Association.

In the study presented at the American Stroke Association’s International conference, University of Cincinnati researchers examined hospital records from 437 patients with diagnosed mild ischemic stroke in the Cincinnati/Kentucky region in 2005. Patients arrived at the hospital within 3.5 hours—within the 4.5 hour window for tPA treatment. Less than 1% - only four patients—received tPA. The researchers found an additional 150 patients who might have also been treated with tPA if stroke mildness were not factored in to treatment plan.

When the researchers extrapolated their results to the U.S. population, they concluded that 2,176 to 3,761 fewer patients per year would be disabled after stroke if treated with tPA. They conclude that would save an estimated $200 million in disability costs per year.

“Currently, there is no standard of treatment for patients with the mildest strokes, even if they come into the emergency department quickly enough for intravenous tPA, the only proven treatment for a more serious stroke,” according to lead researcher Dr. Pooja Khatri of the University of Cincinnati Academic Health Center in Ohio.

Khatri explained that “it was believed that patients with milder strokes would recover from these events. These findings raise the question of whether the mildest strokes should be treated with intravenous tPA.”  She says that further studies are under way to examine the use of tPA for milder strokes.

Stroke is the No. 3 cause of death, after heart disease and cancer, and the leading cause of adult disability according to the American Stroke Association.

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