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Preview: Comments on: TPA and Stroke 2

Comments on: TPA and Stroke 2

Ramblings of an Emergency Physician in Texas

Last Build Date: Sat, 02 Dec 2017 13:18:31 +0000


By: Joe Rich

Sun, 25 Apr 2010 04:40:30 +0000

I've suffered several "mild" strokes, and the times that I arrived at the Emergency Room well within the three hour window, tPA was never offered as a viable treatment because my strokes were too "mild to treat". Now I'm left with permanent brain damage and resultant cognitive losses and persistent left facial numbness and left calf muscle numbness. All because we have a bunch of ER doctors and neurologists in this country who more afraid of lawsuits and litigation and care less about preserving the brain and future of a stroke victim. I would have rather rolled the dice and faced death from a clot-busting medication than wind up the way I did from the strokes I suffered, and so would anyone else who's suffered a stroke and is stuck with the residual effects and aftermath. 'Nuff said.

By: Nuclear Fire

Tue, 06 Apr 2010 04:53:34 +0000

Diffusion MRI is SOC at the facility I'm associated with and are performed within 30 minutes of notification. All "code strokes" are run by neurologists 24/7. Seems like the ER docs like that as they can call any neurological symptoms a "code stroke" and dump the patient for a few hours. It also seems like an easy way for small town hospitals to transfer patients to the big city facility. No offense to the ER docs, but it's the neurologists that have to provide ongoing care to the patients in the hospital and at follow up, so they have a bit more skin in the game.

By: Dave Hardy

Sun, 14 Feb 2010 03:32:16 +0000

This is the mass media. Their job is entertainment, with at least a little basis in fact. "There is some quick cure for a major disease, but doctors haven't gotten the message" is entertaining, in the sense that it grabs the attention (and thus readership for their ads). The degree to which it is true is of far lesser importance.

By: Soccerdoc

Mon, 08 Jun 2009 07:04:04 +0000

Why does it seem that every pro-tPA article (including NYT cited here) includes an anecdote about a patient who receives tPA and recovers immediately? Has anyone actually read NINDS? What is the short-term benefit from tPA for stroke? NONE! IF you trust the data, the most you can claim is measurable benefit at 90-120 days. The most recent trial (ECASS-3, telling us we can push the window to 4.5 hours) doesn't even report data before 90 days. So... to answer the question "What are your outcomes?", most of us in the ED can only comment on our complications. Our successes will not been known (or knowable) for 90 days.


Tue, 16 Dec 2008 17:57:16 +0000

Then pay close attention to the National Institute on Health Data. That would be NINDS for the non medical folks. Cut and Dry 6.4 % SICH rate and a 1/3 more patients have minimal to no disability at 3 and 12 months. Distort the data however you choose but I've sat through many lectures from experts(in research and practice) in the field of stroke who live and practice by these data. Keep in mind that this was before imaging was any good, and SICH was defined as blood on CT and ANY change in NIH. NIH is very subjective and a 1 pt change could be seen very easily with no patient change at all by simply changing the person doing the rating. That's why the definition of ICH has been changed for more recent studies such as SITS MOST (1.7% SICH)to 4 pt change and blood on CT. You can ignore drug company sponsored studies if you choose but 95% of all studies are funded by them. So if you blanket that philosophy you can't posibly practice evidence based medicine. What do those of you that don't use TPA do for your pts within 3 hours of stroke onset? Just curious? What are your outcomes? How do those compare to the current TPA data?

By: Goatwhacker

Tue, 16 Dec 2008 04:02:28 +0000

Do you just ignore the “unbiased data” reviewed by collegues to come to these guidline decisions? It's the biased data that I ignore, which is a hell of a lot of it.


Mon, 15 Dec 2008 18:16:14 +0000

BR Drexinger said "I have seen for years ER docs, FP docs. interists neuroogists and neurosurgeons take exceent care of people with strokes without the help of the government, JCHA, journalists/NYT and drug companies “unbiased data”. What is excellent care of stroke patients??? Heprin and a nursing home? There is "NO" other medical treatment for stroke patients at last I checked. What about the guidlines from the AHA/ASA? TPA has their highest recomendation when given within 3 hours and no contraindications are present. Do you just ignore the "unbiased data" reviewed by collegues to come to these guidline decisions? If there were less of us that thought that "excellent care" has been given up to this point there would be no need for "the help of the government, JCHA, journalists/NYT and drug companies".

By: Doug Johnson

Fri, 10 Oct 2008 01:25:23 +0000

I had a stroke Oct 4 and was given TPA within the 3 hr window. It was 2 blood clots and considered a major stroke. I was released Oct 7 from the hospital and feel good although a little weak on my left side and slight slurring of some speech. TPA saved my life.

By: BR Drexinger

Fri, 15 Aug 2008 05:56:57 +0000

I know this is a dumb question but how much of this is financilly driven(by what looks like multiple recepients, but definately not true patients or those of us routinely taking care of them) Whatever happenned to first do no harm?

By: BR Drexinger

Fri, 15 Aug 2008 05:49:07 +0000

I am a neuroogist in the Atanta area for about 20 yr. This whole thing is discusting I can only give own single personal opinion, but I doubt most practicing neuroogists share the opinions of the ones quoted in the NYT article.l Do those guys realy see many patients or do they sit in ivory towers, revieing papers and teling others how smart they think they are? I'm not competely convinced one way or the other if TPA is a goodthing(but it's definately way overrated) It seems these limited amount or people quoted are trying to pin us against each other ER docs, neuroogists etc. I don't see this happen in real life in my neck of the woods I have seen for years ER docs, FP docs. interists neuroogists and neurosurgeons take exceent care of people with strokes without the help of the government, JCHA, journalists/NYT and drug companies "unbiased data"