What's the "Golden Hour," and What Does It Mean for Strokes?

8 answers | Last updated: Oct 29, 2016
A fellow caregiver asked...

What's the "golden hour," and what does it mean for strokes?

Expert Answers

Jeremy Payne, M.D., is the medical director of Banner Good Samaritan Stroke Center in Phoenix, Arizona.

In stroke care, the term golden hour is used to designate the hour immediately following the onset of stroke symptoms. (Trauma centers use the general term golden hour to indicate the first hour after a trauma has occurred.)

The reason it's "golden" is that stroke patients have a much greater chance of surviving and avoiding long-term brain damage if they arrive at the hospital and receive treatment within that first hour.

Even more specifically, treatment within the golden hour is more successful because patients are candidates for the powerful clot-busting drug known as tPA (short for tissue plasminogen activator), which must be given within the first few hours after a stroke.

For that reason, it's important to be aware of the symptoms that should send you to the emergency room to take advantage of the golden hour: A feeling of numbness, palsy, or paralysis on one side of your body; speech problems such as slurring or not being able to think of or form words; or blurred or blocked vision in one eye are the most common. Some people also have an extreme headache that starts suddenly.

The American Heart Association (AHA) this year announced the results of a large study showing that if you arrive at the hospital within the golden hour, you double your chances of receiving tPA. The study reviewed patients from hospitals participating in the AHA's Get With the Guidelines"“Stroke program and found that 28 percent of patients who arrived within the first hour received tPA, while only 13 percent of those arriving between two and three hours after having a stroke received the drug.

Community Answers

Jaci answered...

tPA isn't always given ~ no one ever said why

My husband had a stroke 9/08 I had him in emergency within a half hour of symtoms ~ doctors and nurses were talking and I saw a syringe in one of their hands ~ my husband was not given any injection ~ what desingnates not giving the tPA?

Thank you

Patricia waller answered...

I had a stroke went to hosp.had a ct scan which showed I did have a stroke but I was not given any meds and then it took 2 weeks to see my primary dr,since I gould not get past the front desk(so much for voice mail in dr's offices).I finally called and threatend to get another dr thenI was in the very next day.I did change drs because I was put into hosp 2 years later and discovered I was a diabetic and all she could say i cheched your glucose levels every time i did blood work.WEll my a1c was 7.2.Come to find out i was a diabetic for at least 6 years.This is why I had a stroke and have a blocked artery in my heart and blocked arteries in my head.Can't do anything bout the head.So I live with it and enjoy my life and work to keep my sugar down low.

Jillg78 answered...

Jaci, Not all stroke patients are candidates for the tpa even if you receive treatment within the first hour. Candidates are anyone having a stroke as the result of a clot. If they have had a stroke with an aneurysm, they cannot use the clot-busting drug.

Oc1dean answered...

tPA does not always work to reverse the damage. I received it within the first hour and still ended up with a massive dead spot in the motor and pre-motor cortex. It probably saved my life but don't expect miracles from it.

Ca-claire answered...

tPA is only for those strokes caused by a clot (embolic or ischemic strokes). It helps dissolve the blockage causing the stroke. For Hemorrhagic strokes, tPA would be ineffective and could possibly cause more damage.

Loving nana-northern california answered...

I am still so confused, My husband had a stroke, he was at the hospital within an hour and he was never given anything. He had a CT scan and all they told me was it was a very bad stroke. After a week in the hospital and a long rehab, we finally saw our neurosurgeon who looked at the CT and gave us the truth, the stroke had completly collapsed the right ventricle of his brain. He said there was no function left there. My husband had to go to a memory care clinic as his mental function is nill. He started getting very agitated after the stroke and is so hard to handle. He can no longer stand or walk and suffers from 2 other neurological diseases, but the stroke is what made him so much worse. Now I learn about this shot and it is too late for my husband.

A fellow caregiver answered...

I am sorry to hear about your husband's outcome Nana. Unfortunately tpa is not for everyone. There is a long list of inclusion/exclusion critieria and the risk and benefits must be weigh in. If the blood pressure is too high the patient is not a candidtae for tpa. If the stroke is too large or too small the patient is not a candidate for tpa. If the patient is taking anticoagualants, had a previous stroke or has kidney failure the patient is not a candidate for tpa. The major side effect of tpa is bleeding in the brain. Because of this, doctors tend to be extra careful in choosing their candidates. Just know that you did the right thing by seeking help right away. with your actions you gave your husband an opportunity to get the best treatment possible and you probably saved his life by calling for help right away. Very few people receive tpa. Most of the time is because the person ignores the symtpoms and seeks help too late- 4.5 hours or later. I hope you have means to provide your husband with the care that he needs. Take care and take care of yourself. stroke affects the care giver as much as it does the person suffering the stroke.