Stroke Care: A Balanced Approach to the tPA Debate

In conclusion, alteplase is the only treatment available for acute ischemic stroke that is effective in some patients. In order to improve tPA effectiveness and minimize risks, patients with symptoms suggestive of an AIS should get rapid assessment and treatment with tPA after careful review of the contraindications. Given that smaller strokes can still be associated with considerable long term neurological morbidity, treatment should still be considered in those patients after weighing the risks and benefits and in consultation with the patient and family. Advanced age should also not be a limiting factor. Although the NINDS trial showed an increased risk of sICH in patients over 75 years old, there was no difference in mortality at 90 days and those patients still had an improved functional outcome and, therefore, stand to benefit from tPA if given within 3 hours of symptom onset. Patients over 80 years old were excluded from the ECASS III study, so at this time we do not know the specific risks of treating older patients beyond the 3 hour window so that decision should also be made in consultation with the family regarding risks. After tPA treatment, it is important to control the blood pressure and avoid the use of antiplatelets or anticoagulants in order to minimize complications. Regardless of the controversy surrounding the use of tPA for AIS, as emergency physicians, we owe it to the patient to present all treatment options with review of the risks and benefits of eac...
Source: EPMonthly.com - Category: Emergency Medicine Authors: Tags: Uncategorized Source Type: news