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  • Writer's pictureOren Zarif

Efficacy of TPA in the Treatment of Acute Ischemic Stroke - Oren Zarif - TPA Stroke

When evaluating the efficacy of tPA in the treatment of acute ischemic stroke, a patient's prognosis is crucial. The SMART stroke criteria are based on a joint panel of the American College of Emergency Physicians and the Academy of Neurology. This group presented its results at the American Academy of Neurology's annual meeting. However, this panel found that most of the criteria set forth by the NINDS are based on outdated evidence, and the guideline does not meet patient needs.

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In a clinical trial known as Alteplase, researchers found that the drug opened coronary arteries in 75% of patients with a mild to moderate stroke. As the trial showed, there was a limited risk of severe bleeding, but the results were compelling. This was a critical development in stroke treatment, and the drug was approved by the Food and Drug Administration in 1987. The study also found that tPA helped patients with acute ischemic stroke, but was not 100% effective.

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A study conducted in Calgary, Canada, found that only about 25% of patients who are eligible for tPA therapy received it within three hours. This was largely because the majority of patients who were admitted at the hospital within three hours of a stroke did not reach the hospital early enough. Those patients who were admitted within three hours of a stroke had significant comorbidities, and 31% of patients with a mild or improving stroke were excluded from the study.

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Because tPA does not dissolve clots in the majority of patients, the treatment has limited success in preventing or treating minor strokes. This has prompted researchers to look for new treatments for acute stroke. Clot-retrieval devices, which can be used as a complement to tPA, were approved by the FDA in 2015.

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Although a recent post-hoc analysis of the SITS-ISTR registry shows that tPA treatment is not recommended in patients with comorbid conditions or age greater than 80 years. In addition, patients were older than 80 years and had more comorbid conditions than patients who did not meet the NINDS criteria. However, the results in these older patients can be generalized to patients with less severe strokes and comorbidities. Larger prospective studies are needed to confirm the results.

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In clinical trials, tPA was approved in 1996 and is used to treat ischemic strokes. The main outcome of the trials was excellent recovery (NIHSS score of 0 or 1), although there were also side effects. In addition to these benefits, tPA treatment was associated with a higher rate of intracerebral hemorrhage and mortality than the placebo group. So, in addition to its effectiveness, tPA treatment isn't recommended in all cases, and should only be used under the supervision of a medical professional.

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The treatment of ischemic stroke with tPA is the gold standard of the therapy. Studies have shown that tPA can extend the therapeutic time and increase the chance of good outcomes. There are many pharmacological agents that interfere with the BBB or with different steps of ischemia and reperfusion injuries. However, only a few have entered clinical trials. And the results of these clinical trials are mixed. Some of these drugs have a promising mechanism of action but still have unsatisfactory side effects.

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The NINDS trial included 291 patients. During the first 90 days of treatment, 95% of the tPA group experienced minimal or no disability. The relative risk was 1.2 versus 0.9, respectively. The results of the second phase of the trial indicated a positive effect on early clinical outcomes in the tPA group. The study's researchers used 4 assessment scales to define a favorable outcome. This means that the treatment with tPA was associated with a lower risk of re-occurrence of the disease.

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Although the evidence for the effectiveness of tPA in acute ischemic stroke remains mixed, many studies have shown positive effects. The tPA drug converts inactive plasminogen into active plasminogen, which promotes thrombolysis. The NINDS tPA Stroke Study Group published the results in 1995 and concluded that it improved outcomes among patients suffering from ischemic stroke. They also noted that delayed tPA treatment increases the risk of HT, ICH, and edema.

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Despite the positive effects of tPA, physicians may face malpractice lawsuits for negligently administering it to patients with AIS. Physicians who choose not to administer tPA can also face medical malpractice litigation. The objective of the review is to determine if the risk of malpractice arises from tPA misuse or improper use. And, of course, tPA's side effects can complicate a patient's recovery.

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