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  • Writer's pictureOren Zarif

Is TPA Stroke Treatment Right For You? - Oren Zarif - TPA Stroke

Although tPA is a promising treatment for acute ischemic stroke, it can have side effects, including bleeding in the brain. In addition, tPA has not been shown to be a good choice for all patients. In order to determine if it is the right treatment for a specific patient, a joint development panel from the American Academy of Neurology and the American College of Emergency Physicians was appointed to develop a clinical evidence-based guideline.

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The Stanford stroke team has used tPA successfully since 1996 and has actively trained other hospitals to use it safely. After tPA was approved, the NINDS launched a public education campaign to inform the public about stroke symptoms and the importance of getting to a hospital as quickly as possible. Its Know Stroke campaign reached millions of people, including Spanish-speaking communities. In addition, the study suggests that tPA is not the best treatment for minor strokes.

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The study compared the outcome of patients treated with tPA versus EVT alone. In a prospective endovascular database collected between 2012 and 2019, tPA was given to patients after transfer from a radiology suite to the emergency department. In the NINDS trial, major protocol violations were reported in 9% to 67% of patients. In the STARS trial, however, most participating centers followed the tPA study protocol. Overall, the study's outcomes were similar to those of the NINDS study. Further, two large registries reported similar rates of mortality, disability, and intracerebral hemorrhage.

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Another study found that tPA treatment can improve the survival of patients with ischemic stroke. It is important to note that tPA can only be administered in the first three hours after a stroke. The time needed to deliver a positive outcome in a patient after tPA is administered depends on several factors. One of the most important variables is the severity of stroke. Earlier tPA treatment could improve the patient's outcome but not the treatment itself.

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During ischemic stroke, vascular remodeling factors are increased. The microvascular structure is destabilized. The resulting ICH and HT outcomes depend on delayed vessel reperfusion. Furthermore, tPA is neurotoxic and may increase the risk of vascular remodeling. The results of this study suggest that delayed combination therapy may improve the neurological outcome of patients with tPA stroke. It is important to note that the study was conducted on rats using both therapies.

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In 1996, the NINDS Stroke Study Group published the results of a large multicenter clinical trial of tPA for acute ischemic stroke. The trial showed that tPA had a 30 percent relative risk reduction compared to placebo. Despite these promising results, tPA remains the only approved drug for acute ischemic stroke. However, the drug is vastly underutilized despite being proven safe and effective in most patients.

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The results of this study are related to the center of the hospital where the patients are treated. For example, if the patient was treated within three hours of onset of symptoms, tPA was more likely to improve health outcomes. However, the benefits of tPA were lost after 270 minutes. This study shows that the time frame between the onset of symptoms and tPA administration is important. Moreover, the use of tPA can decrease the OTT, a delay that increases the risk of complications.

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Despite the benefits of tPA, there is still a long way to go before it is widely used in routine practice. For example, there are many factors that can reduce the rate of tPA delivery in acute stroke, including late-onset and delayed diagnosis. Additionally, access to tPA treatment is highly dependent on the quality of healthcare and health system, and these factors may limit the use of this medication in many settings.

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Because tPA is still underutilized in AIS, physicians are at risk for malpractice lawsuits if they fail to give it to patients. In the ARTSS-IA trial, physicians were found to be liable for failing to administer tPA and a patient's condition. In the study, all 10 patients received tPA with argatroban before the EVT procedure. The use of tPA with argatroban did not significantly delay time metrics. Nine of the 10 patients had good reperfusion and did not develop any symptomatic ICH or a medical complication from EVT.

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