Emergency Medicine Literature of Note
Musings on Emergency Medicine, Clinical Informatics, & High-Value Care.
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”
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”
I, among many others, have been highly skeptical of thrombolytic therapy and its role in the treatment of acute ischemic stroke. As has been well-documented, a few trials were positive, many were neutral, and a few were stopped early for harm or futility. To most of us, this indicates a therapy for whom only a … Continue reading “MR-CLEAN & the New Golden Age”
Interestingly, it especially killed people who were going to have a favorable outcome with standard care. This is MR-RESCUE, a trial evaluating the efficacy of endovascular mechanical thrombectomy for acute ischemic stroke. Patients were eligible for this trial up to 8 hours from stroke onset, and most were enrolled because they were outside the window … Continue reading “Mechanical Embolectomy Kills People”
As we’ve learned from prior publications, the conclusions section of the abstract is the ideal location to “spin” your article to generate news releases. This article, from JAMA Neurology, compares thrombolysis to endovascular intervention for acute carotid artery occlusions and states “Intravenous thrombolysis should be administered as first-line treatment in patients with early cervical ICA … Continue reading ““Say Anything”, Regardless of the Data”
This article is just a retrospective, consecutive case series from Spain reporting outcomes and adverse events from mechanical thrombectomy in acute stroke. Most of their patients are significantly disabled from their strokes, with NIHSS ranging from 12 to 20 – unlikely to have great outcomes – but 14% developed intraparenchymal hemorrhage and 25% were deceased … Continue reading “Mechanical Thrombectomy – Promising, But Still Unsafe”
Catheter-based endovascular treatment of acute ischemic stroke has been around for several years – this is a nice, concise review of the published literature regarding their use. The abstract sounds a little more favorably skewed than the actual content of the article – their discussion is appropriately skeptical regarding the efficacy and applicability of this … Continue reading “Neurothrombectomy Devices – Still Not The Answer”