Tissue plasminogen activator (tPA) in acute ischaemic stroke: time for collegiate communication and consensus.
Systematic reviews of randomised trials of tPA in acute ischaemic stroke indicate a clear benefit of treating selected patients within 3 hours of stroke onset. Moreover, a net benefit remained after adjustment for chance baseline imbalances between subgroups in stroke severity within one of these trials (National Institute of Neurological Disorders and Stroke [NINDS]). Rates of favourable outcomes and intracranial haemorrhage comparable with those in randomised trials can be achieved in routine clinical practice; however, translation of net benefit from tPA therapy requires organised and coordinated stroke management across the continuum of care. Prerequisites for well organised and coordinated acute stroke care are: consensus among care providers on the use of tPA; stroke-care teams spanning the gaps between pre-hospital care, emergency departments and stroke units; and collegiate relations and effective communication networks between care providers.
Levi
Christopher R
CR
Department of Neurology, John Hunter Hospital, New Lambton Heights, NSW. christopher.levi@hunter.health.nsw.gov.au
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007400:Interprofessional Relations; D020521:Stroke / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator