STROKE SERIES SS10. Understanding thrombolysis treatment For stroke

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1 STROKE SERIES SS10 Understanding thrombolysis treatment For stroke

2 Chest Heart & Stroke Scotland improves the quality of life for people in Scotland affected by chest, heart and stroke illness, through medical research, influencing public policy, advice and information and support in the community. The information contained in this booklet is based on current guidelines and is correct at time of printing. The content has undergone peer, patient and expert review. If you have any comments about this booklet please or tel:

3 Understanding thrombolysis treatment For stroke Introduction 2 What is a stroke? 3 What are the effects of stroke? 5 What is thrombolysis treatment? 5 What are the benefits and risks of thrombolysis treatment? 6 What determines whether I receive the treatment? 7 What is a tele-consultation? 8 How is treatment given? 10 What happens after the treatment? 10 Summary 11 This booklet was created with the support of members of the Managed Clinical Network for Stroke, NHS Lanarkshire, and the Scottish Centre for Telehealth, NHS Scotland. It involved consultation with patients affected by stroke, their relatives / carers, health professionals and ongoing research studies. Understanding thrombolysis treatment for stroke 1

4 introduction This booklet provides general information about the treatment known as thrombolysis. It explains when the treatment is used, what is involved and what the possible risks are. It is not a substitute for discussion between you and your doctor. If you have any questions, please ask the doctor or nurse looking after you for more information. See the CHSS booklet Stroke: a guide to your recovery for more detailed information. 2 Understanding thrombolysis treatment for stroke

5 What is a stroke? A stroke is caused by an interruption of the blood flow to your brain, by either a blood clot or a burst blood vessel. Most strokes occur due to a blood clot which blocks the blood supply to part of your brain. As a result, brain cells are deprived of oxygen and other nutrients which they need. This can cause some brain cells to be damaged and others to die. A clot can block an artery (thrombosis). An artery can burst and bleed (haemorrhage). Understanding thrombolysis treatment for stroke 3

6 Stroke is a medical emergency. With 13,000 people in Scotland having a stroke every year it is essential that people can recognise a stroke when it s happening and take prompt action. The FAST test (Face, Arm, Speech, Time) can be used by the general public and paramedics to recognise a stroke prior to a person being admitted to hospital. FAST requires an assessment of 3 specific symptoms of stroke: If a person has failed any one of these tests, it is important to call 999. By calling 999 you can help someone reach hospital quickly and receive early medical treatment, such as thrombolysis. 4 Understanding thrombolysis treatment for stroke

7 What are the effects of stroke? The effects of stroke depend on the area of brain affected and the severity of the damage. Common effects of stroke are: weakness and / or changes in sensation down one side of your face and body, difficulties with swallowing and / or speech, eye problems, and difficulties with understanding. The stroke may lead to some permanent damage. After a stroke about 30% of people will be fully independent within 3 weeks, and 50% by 6 months. Unfortunately, some people will not make a full recovery and some people will die. What is thrombolysis treatment? Thrombolysis means the breaking up of blood clots. Thrombolysis or clot-busting medicine is available to dissolve the blood clot which is the most common cause of stroke. This treatment is not appropriate if your stroke has been caused by a burst blood vessel. Thrombolysis treatment could possibly improve the blood supply to your brain and this could improve your chances of getting better after your stroke. These clot-busting medicines can be used to treat people with heart attacks as well. Understanding thrombolysis treatment for stroke 5

8 What are the benefits and risks of thrombolysis treatment? Thrombolysis treatment must be thought about carefully. So far, clot-busting treatments have been tested in over 7,000 patients with stroke. Thrombolysis treatment can improve the blood supply to your brain and reduce the effects of your stroke. For some people it can reduce the level of long-term disability. However, blood clots vary in size and make-up and thrombolysis treatment does not always cause the clot to dissolve. Overall, more people may get better with thrombolysis treatment. About 10% of people treated will make a better recovery than expected. Thrombolysis treatment appears to increase the number of people who are able to manage without help from others in the months following a stroke. Unfortunately, thrombolysis treatment can have some serious side effects. Because it dissolves blood clots, there is a risk of bleeding for the first day or so after treatment. Some of the bleeding risks are minor, e.g. a small amount of blood oozing from an injection site. The most important side effect is bleeding in the brain. For a small number of people (about 5%) bleeding in the brain could make a stroke worse or be fatal. This type of bleeding can also occur naturally in people with a stroke who have not received any thrombolysis treatment. Despite the best medical care, some people will die in the first few weeks after a stroke. 6 Understanding thrombolysis treatment for stroke

9 What determines whether i receive the treatment? A number of factors determine whether you receive thrombolysis treatment. The treatment is most beneficial if it is given as soon as possible after your stroke to increase your chances for recovery, and has to be given within 4.5 hours of the onset of your stroke. You need to have a brain scan to identify what kind of stroke you have had and to assess the extent of the damage the stroke may have caused. Thrombolysis treatment can only be given when a blood clot has caused your stroke as the treatment is not appropriate if your stroke has been caused by a burst blood vessel. Understanding thrombolysis treatment for stroke 7

10 There has been awareness-raising among paramedics, doctors and nurses to ensure a fast response and timely assessment, diagnosis and treatment. However, thrombolysis treatment can only be given in hospitals where the doctors and nurses have had training and experience, and resources are available to allow it to be used safely and properly. Not all hospitals in Scotland can currently offer this service and some hospitals can only offer the treatment within certain times. The consultant in charge of your care will discuss whether thrombolysis treatment is a possible option for you or not. What is a tele-consultation? Many areas of Scotland are using tele-consultation to support giving treatments. Tele-consultation is a modern method of visual communication between the consultant and you, the patient. By using this method of communication, you can be seen quickly by a consultant experienced in stroke medicine, even if the consultant is at a different hospital or at home. You will be taken to an area where a television, with a small camera attached, is set up. The consultant can see you clearly: you will also be able to see and speak to the consultant. The consultant will ask you, and your relative or carer, about the onset of your symptoms as well as your general health. The consultant will also be able to see your brain scan. 8 Understanding thrombolysis treatment for stroke

11 This allows decisions to be made about the treatment you will receive. At this stage you will also have the opportunity to ask the consultant questions. Your conversation with the consultant is entirely private and cannot be picked up by anyone else (apart from those present in the room with you). All information will be treated confidentially. If you cannot hear properly or don t understand what is happening, please tell the doctor or nurse present and they will let the consultant know. Understanding thrombolysis treatment for stroke 9

12 how is the treatment given? Thrombolysis treatment is given through a needle into a vein in your arm, via an infusion pump and takes about 1 hour to give. You may feel some discomfort when the needle is put into a vein in your arm. Once in place, this needle does not cause any pain. The treatment itself is not painful. You will be awake during the treatment, and able to tell the doctor or nurse if you feel any pain, feel unwell, or become uncomfortable in any other way. What happens after the treatment? For 24 hours following the treatment you will be observed closely, and have your blood pressure measured. If you have any pain, feel unwell, or become uncomfortable in any other way tell the nurse caring for you. After about hours, you will have a second brain scan to assess the effects of the treatment on your brain. Most patients will be started on aspirin, and / or blood thinning drugs to reduce the risk of further strokes. The amount of time you spend in hospital will be determined by the doctors looking after you and depends on a number of factors including the severity of your stroke and your rate of recovery. See the CHSS booklet Reducing the risk of stroke for more information. 10 Understanding thrombolysis treatment for stroke

13 summary Thrombolysis treatment is not suitable for everyone following stroke. If you have had a stroke, due to a blood clot blocking the blood supply to part of your brain, you may benefit from thrombolysis treatment. Clot-busting medicines can sometimes reverse the stroke and speed recovery. However, treatment can sometimes cause bleeding in the brain, which could make the stroke worse. Bleeding in the brain can sometimes be fatal. Overall, more people may get better with thrombolysis treatment. If you have any questions please ask the doctor or nurse caring for you or phone our Advice Line nurses on Understanding thrombolysis treatment for stroke 11

14 Contact the Chest heart & stroke scotland advice line nurses for confidential, independent advice. the line is open monday Friday or out of hours answering machine Understanding thrombolysis treatment for stroke

15 STROKE PUBLICATIONS booklets ss1 Stroke: a guide to your recovery ss2 Stroke: a carers guide ss3 Reducing the risk of stroke ss4 You ve had a stroke ss5 Understanding TIAs and minor strokes ss6 Sex after stroke illness ss7 Stroke in younger people ss8 Coming to terms with a stroke ss9 Thinking and behaviour issues after stroke ss10 Understanding thrombolysis (clot busting) treatment for stroke h4 Living with high blood pressure asj1 Aphasia Stroke Journey: Part 1 Early days asj2 Part 2 Rehabilitation asj3 Part 3 Moving On Csb Conversation Support Book 5 (one copy free) idc Aphasia ID Card Children s Resources (contact us / see website) FAST campaign resources (contact us / see website) Video/dVds Stroke Matters 5 A full publication list is available from Head Office. Rosebery House, 9 Haymarket Terrace, Edinburgh EH12 5EZ Tel: F1 F2 F3 F4 F5 F6 F7 F9 F10 F12 F13 F14 F15 F17 F18 F22 F23 F24 F26 F29 F30 F31 F33 F37 F38 stroke Factsheets Smoking Salt Cholesterol Warfarin Helping communication after stroke Holidays Insurance companies Driving after a stroke 10 common questions asked after a stroke Continence problems after stroke Air travel for people affected by chest, heart and stroke illness Visual problems after stroke Memory problems after stroke Diabetes: links with heart disease and stroke Coping with tiredness How to make the most of a visit to your doctor Living with stress and anxiety Healthy eating Understanding help in the community Swallowing problems after stroke Just move! Carotid endarterectomy Understanding central post stroke pain (CPSP) Coping with low mood / depression Understanding functional limb weakness Please send me the following: ORDER FORM title no. of copies Up to 100 booklets free, up to 100 factsheets free If you wish to order more than 100 booklets or factsheets please contact the Health Information department at the address above. Name: Address: Postcode: Tel:

16 Chest heart & stroke scotland is a wholly independent scottish charity. We receive no core funding from government or any public body or private agency. We need your help to achieve our aim of improving the lives of those in scotland with chest, heart and stroke illness. see insert for more information. ContaCt Us Head Office Tel: Fax: Rosebery House 9 Haymarket Terrace Edinburgh EH12 5EZ Open Mon Fri Glasgow Tel: Fax: Clarkston Road Glasgow G44 3BL Open Mon Fri Inverness Tel: Fax: Mealmarket Close Inverness IV1 1HT Open Mon Fri Registered with and regulated by the Office of the Scottish Charity Regulator (charity no SC ), Chest Heart & Stroke Scotland and CHSS are operating names of The Chest, Heart & Stroke Association Scotland. Also registered in Scotland as a company limited by guarantee, no SC February 2013 Designed by Creative Link, North Berwick

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