New medication for ICH stroke patients is coming
New medication for ICH stroke patients is coming
A patient comes to your ED with intracerebral hemorrhage (ICH), the deadliest and least treatable form of stroke, which accounts for 15% of strokes and nearly half of the 164,000 stroke deaths in the United States annually. Right now, there is very little you can do for this patient, but that may change soon.
NovoSeven Coagulation Factor VIIa (Recombinant) (manufactured by Princeton, NJ-based Novo Nordisk Pharmaceuticals) was shown to reduce hematoma growth, decrease mortality and morbidity, and improve neurological outcome, says Stephan Mayer, MD, associate professor and director of the neurological intensive care unit at Columbia University Medical Center in New York City, and the study’s lead author.1
The trial results were spectacular, Mayer reports. "For the first time ever, we may have an effective ED treatment for brain hemmorrhage," he reports. "We will move from a paradigm where there is not much you can do except call neurosurgery — and there is no real evidence that operating works anyway — to actively intervening within minutes of identifying bleeding in the brain."
After ICH patients come to the ED, they typically worsen quickly and sink into a coma, Mayer says, who hopes this drug will stop that sequence of events. "The treatment is not the kind of thing that will make somebody just wake up and jump off the bed; it’s not going to work that way. What it will do, though, is prevent progressive bleeding in a substantial amount of patients."
The treatment will "breathe new life" into stroke care in the ED, he predicts. Those first few hours in the ED are the most critical few hours of any stroke patient’s life, because that’s the only time your interventions will work, Mayer adds. "It’s the make or break time. EDs should be managing brain attack the same way we would a gunshot wound to the head — and in fact, we have a lot more we can do for stroke than gunshot wound."
To use NovoSeven, EDs would need to address rapid implementation of new treatment protocols, says Lauren Brandt, RN, MSN, CNRN, clinical director of the Neurosciences, Brain & Spine Center at Brackenridge Hospital in Austin, TX. "This would be a really big step for this patient population."
ED nurses need to be aware of this new research and what it will mean in the future, she says. "This type of stroke has few, if any, options for treatment — and this study looks very promising," Brandt says.
Currently, there isn’t much you can do for these patients in the ED, says Brandt. "Thrombolytics are contraindicated since they already have bled, and surgery has not been found to change outcomes," she says. "Most things we do are supportive, such as blood pressure control, blood glucose control, and airway protection."
ICH strokes typically can’t be distinguished from ischemic strokes until the computerized tomography (CT) scan is done, so patients should be triaged the same way, advises Brandt. She recommends developing a triage system to ensure that patients with stroke symptoms have a CT scan and labs performed, and time of onset identified. Subsequently, based on what the CT scan shows, the appropriate pathways would be used, such as t-PA for ischemic stroke, and potentially Factor VII for intracerebral hemorrhage.
The ED nurse is the key to rapid assessment and triage for all stroke patients, stresses Brandt. "Recognition of stroke symptoms and determining time of onset will continue to be key points in the care of this population," she says. "Also, keeping protocols current will positively impact the stroke population, since it looks like this will add another time-based intervention to our current arsenal of treatments."
Reference
- Mayer SA, Brun NC, Begtrup K, et al. Recombinant activated Factor VII for acute intracerebral hemorrhage. N Engl J Med 2005; 352:777-785.
Sources/Resource
For more information on intracerebral hemorrhage (ICH) stroke, contact:
- Lauren Brandt, RN, MSN, CNRN, Clinical Director, Neurosciences, Brain & Spine Center, Brackenridge Hospital, 601 E. 15th St., Austin, TX 78701. Telephone: (512) 324-7782. Fax: (5120 324-7051. E-mail: [email protected].
- Stephan Mayer, MD, Division of Critical Care Neurology, The Neurological Institute of New York, 710 W. 168th St., Box 39, New York, NY 10032. Telephone: (212) 305-7236. Fax: (212) 305-2792. E-mail: [email protected].
For more information on NovoSeven Coagulation Factor VIIa (Recombinant), contact:
- Novo Nordisk, 100 College Road W., Princeton, NJ 08540. Phone: (877) 668-6777 or (609) 987-5800. E-mail: [email protected]. Web: www.us.novoseven.com.
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