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  • Writer's pictureOren Zarif

TPA Stroke Therapy - Oren Zarif - TPA Stroke


TPA stroke therapy can significantly improve the outcome for patients. However, many patients do not reach the hospital early enough for tPA treatment. Only two in three patients who arrive within three hours are treated with tPA, and the remaining 31% are excluded because their symptoms are too mild or are rapidly improving. This is a problem, but there is a way to address it. Here are the main benefits of tPA treatment.

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Using a tPA-infused IV is highly effective. When administered properly, tPA may be effective in removing the clot. In certain cases, endovascular surgery is required. This procedure is often able to reduce the delay associated with tPA treatment. It is important to note that the faster tPA is administered, the better the results. A recent trial of this treatment showed an improved clinical outcome for patients who had a stroke.

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Another study published in the Lancet in 1975 included patients with a combined NINDS part I and II score. The authors found that IV tPA combined with EVT had superior outcomes. However, a few limitations remain. These include the narrow eligibility of tPA, high risk subgroups, and a shortage of neurological expertise in the community. Further research and education are needed to optimize tPA stroke therapy for all stroke patients. In addition, future studies should focus on enhancing tPA stroke treatment with improved neuroimaging and advanced neuromarkers and alternative reperfusion.

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The only available drug to reverse an acute ischemic stroke is tissue plasminogen activator (tPA). Nevertheless, delayed tPA administration increases the risk of complications such as edema, HT, and ICH. There is an increased risk of reperfusion injury due to tPA. The use of this drug in acute stroke is not recommended unless you have received thorough research and know the side effects of tPA.

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Further research is needed to better understand the reasons for higher tPA stroke treatment rates. However, the literature is mixed in the area of quality improvement and does not provide a consensus on the optimal rate. Moreover, tPA treatment requires substantial resources and engagement in quality improvement programmes. It is vital that health systems make efforts to improve the availability of tPA and thrombolysis. But this change has to be gradual, and requires substantial changes in quality of care.

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Since the FDA approved tPA, various thrombolytic drugs were developed to decrease the side effects of tPA. Among them is tenecteplase, which has been tested in animal studies and may be an appropriate substitute for tPA in future stroke patients. While tPA helpers should be used in conjunction, research will continue to uncover ways to reduce the adverse effects of tPA therapy in ischemic/reperfusion damage.

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Neuroprotective agents have pleiotropic actions in the brain, including activation of extracellular proteases, direct vasoactivity, and enhanced excitotoxicity. These compounds may also reduce the incidence of HT and ICH, which is a major complication of tPA. Although both therapies will significantly reduce brain edema, patients should still undergo tPA as soon as possible. This will help prevent the development of a complication and ensure optimal neurological outcome for patients.

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A few factors have been identified in the NINDS study. These include failure to properly diagnose a patient, failure to transfer the patient to a hospital where thrombolysis could be administered, and improper documentation and informed consent. A final problem with tPA stroke treatment is that it has a very narrow window for treating patients. Nevertheless, these factors are not sufficient to support a claim of malpractice. If the trial fails to show that tPA is ineffective for treating a particular type of stroke, a physician will be held liable for the malpractice.

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Another potential drawback of tPA is its hemorrhagic effect. Some patients will undergo hemorrhagic transformation when given intravenous tPA. As a result, it is important to understand the underlying molecular mechanisms for improved therapeutic efficacy of tPA. However, a lower risk of hemorrhagic transformation could improve a patient's long-term outcome and reduce mortality.

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Minocycline has also been shown to be safe for patients receiving tPA. This study included two small randomized trials that used the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel index. These trials supported the inclusion of minocycline in tPA stroke patients. In addition, two systematic reviews published in 2018 showed that minocycline was beneficial for the treatment of AIS patients receiving tPA.

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