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Medical Forum / General / General / June 2005clotting agent shows promise with worst strokes
Clotting agent shows promise with worst strokes By ANDRÉ PICARD Thursday, June 9, 2005 Page A17 PUBLIC HEALTH REPORTER http://www.theglobeandmail.com/servlet/ArticleNews/TPStory/LAC/200506... In mid-March, Dennis Woon was teaching a class in petroleum engineering at the University of Calgary when he started losing feeling in his right leg. Thinking the leg had just fallen asleep, he carried on. As he chatted with students after class, the numbness spread and he began listing on his chair. Mr. Woon insisted he was just tired: "I didn't have any pain. I didn't have a headache. So I didn't think it was a big deal." But one of his students, recognizing key symptoms of a stroke, paralysis and loss of balance, dialled 911. Within minutes, the 55-year-old was on his way to Foothills Medical Centre. A CT scan revealed that he was suffering from an intracerebral hemorrhage, the most deadly form of stroke, and a condition for which there is no treatment. As it turns out, however, the Calgary hospital was part of a trial testing the use of Factor VIIa, a clotting factor used by some hemophiliacs to treat bleeding in the brain just like Mr. Woon was suffering. Treatment with Factor VIIa cut the death rate by 30 per cent, and resulted in 10 per cent more patients recovering fully from stroke. "The results were quite promising," Dr. Andrew Demchuk, director of the stroke program at Foothills, said in an interview. The numbers are impressive, he said, considering that 40 per cent of people who suffer an intracerebral hemorrhage usually die within 48 hours, and double that number suffer lasting disability. -----snip------ <<Within minutes, the 55-year-old was on his way to Foothills Medical Centre. A CT scan revealed that he was suffering from an intracerebral hemorrhage, the most deadly form of stroke, and a condition for which there is no treatment. As it turns out, however, the Calgary hospital was part of a trial testing the use of Factor VIIa, a clotting factor used by some hemophiliacs to treat bleeding in the brain just like Mr. Woon was suffering. << COMMENT LOL. Then I guess it's a darned good thing he was suffering from the worst kind of stroke, instead of the most common kind of stroke. Cause CT would not have done him any good, *except* to treat hemorrhage. What were they going to do with him if he had had a clot? How would they know he even had a clot? He was in Canada where CT can be found emergently, but the far more expensive functional MRI (fMRI, which you really need to most effectively treat all *other* kinds of stroke) usually cannot (the few fMRI machines in Canada since 1999 are research tools). Even plain vanilla MRI is not easy to get in Canada (they have fewer than 2 machines per million people), and certainly not if you need one within a couple of hours, which you do, with 90% of stroke. Canada ranks lowest of all developed countries in medical imaging adoption-- which means it's worse than some of the third world. http://strategis.ic.gc.ca/epic/internet/inmitr-crtim.nsf/en/hm00135e.html My, but the propaganda machines up there seem to be working, though. THEY don't need liquid helium-bathed superconducting magnets. SBH Calgary, with a population of almost 900,000, has nine MRIs. The MRIs and 12 -plus CTs are in hospitals (all), free-standing publicly-owned imaging clinics, and privately owned clinics (ka-ching). Zee >>Calgary, with a population of almost 900,000, has nine MRIs. The MRIs and 12 -plus CTs are in hospitals (all), free-standing publicly-owned imaging clinics, and privately owned clinics (ka-ching).<< Well, that's 6 times the national average frequency, which I suppose isn't surprising for an urban center. Considering the number of strokes expected in 100,000 people, it's still not enough. And it's a matter of penny-wise and pound-foolish. The cost of stroke is unbelievable because 75% of stroke patients don't die, and many of them have huge rehab and chronic disability costs. These can be cut 20% with rapid treatment in people who get to the hospital in time, and realistically from 5 to 10% figuring in those factors. Even 8% of annual stroke costs buys a lot MRI scanners. How much do 3000 or 5000 stroke patients a year kept out of rehab and chronic care save? I'm guessing 25 K a person at least. Call it $100 million a year. That's 20 new scanners a year bought in a country that only has 50 total. Of course the problem is people who get MRI scanners tend to use them to look at people with low back pain (we have this problem in the US) so it's not just a matter of having the machines. They have to be used wisely. SBH SBH > >>Calgary, with a population of almost 900,000, has nine MRIs. > [quoted text clipped - 4 lines] > Well, that's 6 times the national average frequency, which I suppose > isn't surprising for an urban center. Ever been to Canada Steve? We have oh maybe six urban centres. This is a vast country (about 11 of Texas will fit in my province alone). Your solution isn't ours. What we do have are a lot of air ambulances, both fixed and rotar wing, suberbly trained emergency physicians who work in the back of STOL aircraft, doctors who get their hands dirty and EMTs who do thrombolytic injections between Moose Jaw and Pukatawagan. What else can we do? The information on the website was eight years old, at newest. Perhaps that's the problem. Canada needs more web techies. Considering the number of strokes > expected in 100,000 people, it's still not enough. Vida supra. > And it's a matter of penny-wise and pound-foolish. The cost of stroke > is unbelievable because 75% of stroke patients don't die, They do here. It's a long way from the Belcher Islands to Poste de la Balene and the nursing station. and many of > them have huge rehab and chronic disability costs. We have wonderful rehab and disability facilities. Really. Rehabilitation medicine is superb here. It has to be. These can be cut 20% > with rapid treatment in people who get to the hospital in time, and > realistically from 5 to 10% figuring in those factors. Even 8% of > annual stroke costs buys a lot MRI scanners. How much do 3000 or 5000 > stroke patients a year kept out of rehab and chronic care save? I'm > guessing 25 K a person at least. Call it $100 million a year. That's > 20 new scanners a year bought in a country that only has 50 total. Nah. There's more than that. I know my city has more than Calgary. We are further north and all of Nunavut feeds into us. > Of course the problem is people who get MRI scanners tend to use them > to look at people with low back pain (we have this problem in the US) > so it's not just a matter of having the machines. They have to be used > wisely. Too true. During a recent hue and cry (orchestrated by you?) that my province didn't have enough of MREs, poor people had to wait months to have a bum knee MRI'd. Some columnist made the point, something like "when did physicians stop learning how to diagnose a cruciate ligament tear with a hands-on examination?" Why when someone bought an MRI, of course. Zee > SBH >>Ever been to Canada Steve? We have oh maybe six urban centres. This is a vast country (about 11 of Texas will fit in my province alone). Your solution isn't ours. What we do have are a lot of air ambulances, both fixed and rotar wing, suberbly trained emergency physicians who work in the back of STOL aircraft, doctors who get their hands dirty and EMTs who do thrombolytic injections between Moose Jaw and Pukatawagan. What else can we do? << COMMENT: I've been to Canada many times. More importantly, I've seen population distribution maps of Canada, which are quite comparable to what you see when you look at the Country from space at night. Canada's a big country, but 90% of the population is in the urban centers and also distributed in a thin little line next to the US border. Yes, the small fraction people who live very rurally aren't going to be helped much. But they are a small fraction. >>The information on the website was eight years old, at newest. Perhaps that's the problem. Canada needs more web techies. << The last reference was 2000. But it's true that data about Canadian MRI machines seems to be from 1999. > And it's a matter of penny-wise and pound-foolish. The cost of stroke > is unbelievable because 75% of stroke patients don't die, >>They do here. It's a long way from the Belcher Islands to Poste de la Balene and the nursing station. << COMMENT: I'm using the Canadian figures from your Heart and Stroke Foundation. Again, "vide supra" yourself. It doesn't matter that a relatively small fraction of Canada's population is very far from a major city. Most of it is not. SBH |
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