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Tissue Plasminogen Activator for Stroke Treatment - Oren Zarif - TPA Stroke

Writer's picture: Oren ZarifOren Zarif

The use of tPA in the treatment of acute ischemic stroke depends on a number of factors. These include a quick diagnosis, adherence to a strict protocol and time windows. The latest evidence-based guidelines, published in the AHA/ASA journal, include the eligibility criteria and general recommendations for tPA use. In the future, advances in multimodal imaging may guide the decision to treat stroke using tPA.

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In addition to its wide use, tPA is associated with a number of drawbacks, including its narrow eligibility, the risk of symptomatic intracerebral hemorrhage, and the limited pool of neurological expertise in the community. Still, despite these limitations, tPA remains the most effective treatment for acute strokes. There is a short-term limit to the duration of tPA efficacy.

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The success of tPA has been largely due to a significant reduction in the number of stroke patients who suffer from severe disabilities. This reduction in disability is attributable to the increased availability of tPA and rapid treatment protocols, which improved the quality of acute care for stroke patients. Moreover, the use of tPA has led to dramatic improvements in stroke care. Several hundred hospitals developed specialized stroke teams and developed resources to become primary tPA stroke centers in the U.S. After tPA was approved by the FDA, the NINDS launched a national public education campaign aimed at informing the general public about the signs and symptoms of stroke and the importance of getting to a hospital as quickly as possible. Its "Know Stroke" campaign reached millions of people, including Spanish-speaking populations.

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A recent randomized trial tested the effect of tissue plasminogen activator (tPA) on the rate of recovery after acute ischemic stroke. It compared tPA to placebo in patients with stroke symptoms onset between 0 and six hours after the event. In this trial, tPA was administered in an amount of 0.9 mg/kg IV over 60 minutes, with the optimal dose at 90 mg. This study ended prematurely after enrolling 142 patients, but the results were similar to other studies.

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In addition to a recent study, a number of tPA stroke trials suggest that tPA may be administered during head CT scans. It would reduce OTT times and increase patient outcomes. However, this proposal has not taken into account the diminished quality of care for other patients. This study also showed that tPA administration during head CT scans can reduce OTT times significantly. The authors believe this could prove to be a game changer for improving the treatment of stroke.

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The first studies of tPA in the treatment of ischemic stroke were conducted in the early 1980s. Although they focused on animal models, there were very few patients who received the drug. The 1980s brought about the biotechnology revolution, allowing scientists to directly express genes and proteins in cell cultures. Genentech, a pharmaceutical company, began producing recombinant tPA in sufficient quantities to support commercialization. The first multicenter randomized trial of tPA began in 1984.

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Several studies have shown that patients receiving tPA have excellent functional outcomes. However, if there is a higher rate of ICH or HT, the treatment may be ineffective. Neuroprotectants may improve outcomes in patients treated with tPA and delay ICH formation. The study showed that patients treated with tPA were significantly less likely to develop ICH than patients who received placebo. The combination of tPA and rA2 therapy improved sensorimotor function and reduced the risk of ICH transformation.

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Studies have found a direct correlation between higher rates of tPA administration and the presence of teaching hospitals. The use of tPA in stroke patients is associated with lower rates of ischemic stroke, but doctors are increasingly being held liable when it is administered inappropriately or incorrectly. To assess the effectiveness of tPA in ischemic stroke treatment, researchers have systematically reviewed 46 cases of ischemia litigation involving tPA and AIS. Twenty-six patients were included in the study, with data on the verdicts of 38 cases.

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Direct administration of tPA in the CT scan room can improve patient health outcomes by decreasing the time it takes to diagnose LVO. Ultimately, this can save lives and reduce delays in treatment. However, there are still many challenges that must be addressed before tPA can be successfully administered. These include patient preparation, logistical barriers between the CT suite and the angio suite, and difficult arterial access. Once tPA is administered, patients can go to the angio table for MT.

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