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Golden Stroke

What is the Golden Hour of Stroke? The ‘Platinum Half-Hour

Researchers have upped the ante on the “golden hour” concept in stroke with their finding that ultra-early stroke intervention is a reachable target. The FAST-MAG trial, originally designed to test magnesium as a neuroprotective agent, had 12.1% of 1,680 stroke patients treated by paramedics within 30 minutes of the time they were last known to…

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Researchers raised the bar on stroke’s “golden hour” concept by proving that intervention in ultra-early strokes is possible.

The FAST-MAG trial, originally designed to test magnesium as a neuroprotective agent, had 12.1% of 1,680 stroke patients treated by paramedics within 30 minutes of the time they were last known to be well, according to Fatima Pariona-Vargas, MD, of Peru’s National University of Cajamarca School of Medicine, and colleagues.

Magnesium administration in this “platinum-half-hour” didn’t result in better functional outcomes over the 3-month period. “However, once a beneficial therapy able to be started in ambulances becomes available, platinum half hour treatment is likely to be associated with maximal intervention benefit,” the authors argued in their paper in Stroke.

Prehospital treatment is likely to be the best way to use stroke interventions within the first half-hour of arrival by EMS, as the time spent waiting for them to arrive and transport the patient was precious, researchers agreed.

The 12.1% rate of treatment within 30 minutes by the FAST-MAG paramedics is “very impressive,” said James Grotta, MD, a vascular neurologist at Memorial Hermann Health System and director of the Houston Mobile Stroke Unit.

“The study highlights the importance and potential benefit of moving treatment to the prehospital setting,” he said to MedPage Now .

Neuroprotective drugs would theoretically be able to provide safe and prompt prehospital treatment for hemorhagic strokes and ischemic strokes. It is hoped that regular ambulances would be able to use the agents to avoid the need for imaging to differentiate between them when they apply intravenous (IV), thrombolysis or other treatments.

A good neuroprotectant may allow rescuers to have more time for other therapies after they confirm that the patient has suffered from a hemorhagic stroke or ischemic stroke. This was stated by Tudor Jovin MD, a stroke neurologist at Cooper Medical School of Rowan University, Camden, New Jersey.

But, researchers have failed time after , time to find a good agent.

NA-1, one of the neuroprotectants still under investigation in the FRONTIER trial

Although FAST-MAG had failed to show efficacy for prehospital IV magnesium <=2 hours of stroke onset, magnesium, being a glutamate antagonist, might still have neuroprotective effects revealed if administered very early and studied in a larger sample, Grotta suggested.

As for speedy reperfusion therapy, he said that tenecteplase (TNKase) shows promise for fast administration — perhaps feasible in the first 30 minutes.

” I believe that in acute stroke treatment we’re entering an era where such approaches are possible,” Jovin stated.

He noted that, in addition to prehospital treatments, it is also necessary for stroke detection to occur faster in the field. Devices are being created to detect strokes as they occur. This is something we used to consider science fiction. He said that it is becoming more real. It may not be widely used yet, but it will soon.

Pariona Vargas and her colleagues had performed an exploratory analysis on the phase III FASTMAG trial.

Study participants had a median age of 69 years, and the group included approximately 45% women. Patients scored a median 4 on the prehospital Los Angeles Motor Scale and 8 on early-hospital NIH Stroke Scale

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