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Week: 524.1 Guest: Wayne Clark, M.D. Topic: Stroke Drugs, TPA & Citicoline - One Part Host: Steve Girard Producer: Ed Graham

NEMA: We spoke recently with Dr. Wayne Clark, Director of the Oregon Stroke Center in Portland....and found out about the stroke prevention drug Warfarin. Today, we'll talk with Dr. Clark about two promising treatments for stroke victims. First, let's get into TPA....

CLARK: "TPA, or tissue plasminogen activator, is a substance that's normally in the body. It goes in and nibbles away at blood clots, and dissolves them. It's almost like liquid Drano for the brain, the idea is it goes where the clog is, opens up the artery, and gets the blood rushing back into the brain with oxygen and whatever other goodies are needed to save the brain."

NEMA: I understand TPA has to be administered quickly.....

CLARK: The key here is quickly...the study that was done, it was a large study all across the country with 600 patients, everyone in that study had to receive the medication within three hours of the onset of their stroke....so you had to know that you were having a stroke, get to the hospital, get a bunch of tests done, and get the medication started all within three hours. Now, if you did all of that, then your chances of having a full recovery if you got the medication, was 50%. If you didn't get the medication, its only 30% chance of a full recovery.

NEMA: Some exciting news about Citicoline....how does it differ from TPA, the clot buster...and how does it help protect stroke victims?

CLARK: Citicoline, by contrast, is more of a building block kind of approach. The brain cells during a stroke are starved of oxygen and begin to break down, almost like a soap bubble popping. Citicoline is a building block of the cell membrane, so if you give lots of Citicoline, it will strengthen the cell membrane and keep it from popping. If you keep the membrane intact, that cell will stay alive and other surrounding cells will be less likely to be involved and die as well.

NEMA: What did the study you participated in show.?...

CLARK: The study that was done looked very promising, with over half the patients having a full recovery that got Citicoline. Now, it was not as many patients and the study was not as large as the TPA trial, so we're not quite as sure about the results. The good news is that this medication was given clear out for 24 hours, so even if you got in after the three hour window, this may be something that could be offered.

NEMA: What does the future hold for these two promising drugs?

CLARK: Now, what I'm hoping down the road is that we'll be able to give both therapies in sort of a cocktail approach. That you could give some Citicoline, there are other agents being tested to try to put the brain in suspended animation, you could use some of those, and...that would buy you time that you'd have a longer window to still use the clot-busters. So, I'm hoping that with a combined approach, we'll do even better than the 50% full recovery, but we'll have a much higher cure rate.

NEMA: But all this is dependent on a victim being aware of what's happening during the onset of stroke....

CLARK: I want to emphasize the idea that if you don't get into the hospital, it doesn't matter what wonderful drugs we have available, it's not going to work. And the patients need to recognize the warning signs...difficulty speaking, sudden loss of vision, paralysis on one side of the body, or numbness on one side of the body. If they have those symptoms, dial 911 and go to the E.R.

NEMA: Dr. Clark says he sees the potential for wide use of TPA to battle the nation's # 3 killer...and more tests on Citicoline should be complete in about a year...with possible approval perhaps six months after that. I'm Steve Girard.

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