Emergency physician attitudes toward thrombolytic therapy in acute stroke.
BACKGROUND
Intravenous use of tissue plasminogen activator (TPA) is the only currently approved treatment for acute ischemic stroke.


METHODS
To determine emergency physician attitudes and practices with regard to thrombolysis for ischemic stroke, a questionnaire was sent to program directors of accredited emergency medicine residencies in the United States.


RESULTS
There were 73 program directors who responded to the survey; 71% of medical centers have used TPA for treatment of stroke. The reported major complication rate for cerebral hemorrhage and death averaged 7%. For nontreating centers, two major factors cited were lack of appropriate patients and concerns regarding the safety of TPA; 48% of the facilities do not have an acute stroke team. Delayed patient arrival and the perceived narrow risk/benefit ratio of TPA were identified as the two greatest obstacles to more widespread use of TPA.


CONCLUSIONS
Although the majority of medical centers that responded in this study have some experience with thrombolytic therapy for acute ischemic stroke, almost one half do not have an acute stroke team and considerable uncertainty exists regarding the safety of intravenous TPA. More uniform national treatment of acute stroke will require greater consensus among emergency physicians and further analysis of the risk/benefit ratio of thrombolytic treatment.
Chaturvedi
S
S
Bertasio
B
B
Femino
L
L