May 26, 2016

Background: Despite continued debate on the efficacy of alteplase (tPA), it currently remains one of the major interventions directed at patients presenting with acute ischemic stroke. The current standard dose of the drug is 0.9 mg/kg given over 1 hour. It is unclear whether lower doses would be equally effective in increasing good neurologic outcomes after stroke while simultaneously decreasing the rate of intracerebral hemorrhage (ICH); the most serious side effect. Evidence showing that lower doses of tPA are non-inferior to standard-dose tPA could lead to a shift in treatment. 

November 9, 2015

I recently returned from the American College of Emergency Physicians (ACEP) Conference which took place from Oct. 26th - 29th, 2015 in Boston, MA.  There were really a lot of amazing talks by so many amazing speakers but one lecture in particular by David Newman, of SMART EM and The NNT fame, made me realize that there is just so much research on treatment of ischemic stroke, that I can't even keep them straight.  So what I thought I would do is create an archive of all that research and continue to add to the list as more research is released.  I don't know about you, but I find myself spending lots of time looking this information up every time I need it. 

April 3, 2014

  For the most part, the biggest concern with administering tPA is the bleeding complications, specifically intracranial hemorrhage. But there is another side effect that is being reported more frequently. I, myself, saw two cases in one week. This side effect is tPA-associated angioedema. Case: A 70-year-old female with a past medical history of hypertension and diabetes presents to your department 45 minutes after onset of left facial droop, slurred speech and left-sided hemiparesis. The initial head CT is negative for acute hemorrhage. You diagnose your patient with an acute ischemic stroke. There are no contraindications, so you decide to treat the patient with tPA (we will leave this debate for another time).