Emergency Medicine Literature of Note
Musings on Emergency Medicine, Clinical Informatics, & High-Value Care.
In yet another exercise in asking the wrong questions, these authors put forth a rather great deal of effort to regurgitate a vast quantity of mostly meaningless data. Neurologists, generally those well-supported by Genentech and Boehringer Ingelheim (as in this article), are keen to expand the use of tPA beyond the license criteria. One of … Continue reading “Again With the Claim tPA is “Safe” in Mild Strokes”
Over 200,000 physicians belong to the American Medical Association. The Journal, therefore, of this Association has a significant audience and a long tradition. Continuing Medical Education inserts in JAMA may represent the basic education of many new developments for general practitioners. Unfortunately, the authors of this most recent CME portion seem to require their own … Continue reading “A Laughable tPA “Systematic Review””
As much of a naysayer I’ve been over the past few years, holding out as a skeptic, waiting for a study to finally settle the issue on thrombolytics in acute ischemic stroke – that day has come. Except, it’s not tPA. It’s a novel isoform of tPA, dissimilar to all of the versions we’re familiar … Continue reading “All Hail n-tPA! [April Fools]”
tPA, the “proven” therapy foisted inappropriately on Emergency Medicine and our patients, doesn’t work. Rather – as I’ve said before – it simply doesn’t work the way we’ve been taught. The core concepts of the theoretical utility of tPA for ischemic stroke are demonstrated nicely in the new endovascular trials. Patients do well, better than … Continue reading “Using CTA to Predict tPA Failures”
“More community hospitals are giving a powerful clot-busting medication to stroke victims, improving their chances of survival and recovery, new research shows.” This statement comes from the American Heart Association press release regarding this synopsis of the Get-With-the-Guideline Registry. Part of this statement is true – more community hospitals are using tPA for acute ischemic … Continue reading “Inappropriately Promoted tPA “Drip and Ship” Safety”
We all have our anecdotal stories from academic medical centers staffed by stroke neurologists, cases in which they have called for thrombolytic therapy in acute ischemic stroke for profoundly inappropriate candidates. Hearing such sad tales, one hopes such rogue uses of lytics are the lunatic fringe, isolated cases of madness and zealotry. But, no. This … Continue reading “Inside a Neurologist’s Mind: tPA For Everyone!”
ACEP has published a draft version of their new Clinical Policy statement regarding the use of IV tPA in acute ischemic stroke. As before, the policy statement aims to answer the questions: (1) Is IV tPA safe and effective for acute ischemic stroke patients if given within 3 hours of symptom onset?(2) Is IV tPA … Continue reading “The Wholesale Revision of ACEP’s tPA Clinical Policy”
As part of every Genentech-sponsored CME or medical school curriculum presentation on thrombolysis in acute ischemic stroke, you see a graph like this: This is the “time is brain” mantra, where every supposed passing second without flow destroys another mass quantity of brain cells. The theory: on the edge of the infarcted brain tissue, there … Continue reading “The “Golden Hour” of tPA”
You know Jerry Hoffman. Do you know Greg Albers? Among his many accolades, he was one of the investigators from the failed trial of ATLANTIS – which, not coincidentally, concluded Genentech’s involvement in randomized trials testing tPA in acute stroke. This past summer, the Oregon Stroke Network hosted Dr. Hoffman debating Dr. Albers, entitled “t-PA: … Continue reading “Hoffman v. Albers tPA Debate from Oregon Stroke Network”
Yet again, the tPA apologists dip into their bag of registry data in an attempt to defend tPA – and end up contradicting themselves. In 2009, neurologists in India published a retrospective case series examining the outcomes following tPA at their institution. Specifically, they divided up the cases between those with arterial occlusion present on … Continue reading “For tPA, Is Delusion the Standard of Care?”