troke was the fifth leading cause
of death in the United States in
2015, and it is the leading cause of dis
-
ability.
1-5
Stroke contributes to more
than 130,000 U.S. deaths annually,
and more than 50% of patients over
65 years of age experiencing their
first stroke will die within 5 years.
1,3
Survivors may have residual speech
and movement difficulties, continued
physical pain, fatigue, and inconti
-
nence.
6
The Brain Attack Coalition
has estimated that the lifetime cost
of an ischemic stroke is more than
$140,000 and the lifetime cost of a
subarachnoid hemorrhage is more
than $225,000.
2
There are two major classifica
-
tions of stroke (hemorrhagic and
ischemic), with the latter type further
classified as transient ischemic attack
(TIA) or acute ischemic stroke (AIS).
In 2014, our hospital discharged ap
-
proximately 920 patients with a di
-
agnosis of AIS, TIA, or hemorrhagic
stroke. Alteplase, or tissue plasmino
-
gen activator (t-PA), is the only Food
and Drug Administration–approved
medication for the treatment of AIS;
however, historically, it has been used
quite infrequently.
7
In most patients,
t-PA needs to be given within 3 hours
of initial stroke symptoms but can be
given within 4.5 hours in select pa