title: Review of tissue plasminogen activator, ischemic stroke, and potential legal issues.
abstract: The use of tissue plasminogen activator in ischemic stroke is controversial. Many practicing physicians believe that its usefulness is established, while others, including professional specialty societies, are less sanguine. A review of the literature appears to show that the use of tissue plasminogen activator is efficacious and can result in highly improved outcomes for a majority of eligible patients. These findings may implicate important potential legal issues. Informed consent concerns and, potentially, medical malpractice claims may result, particularly in the context of evidence-based practice, pay for performance, and the currently limited use of tissue plasminogen activator for eligible patients.
authors.affiliation: Institute of Health Law Studies, California Western School of Law, San Diego, CA 92101, USA. baliang@alum.mit.edu
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Liang
authors.forename: Robert
authors.initials: R
authors.lastname: Lew
authors.forename: Justin A
authors.initials: JA
authors.lastname: Zivin
mesh_terms: D002545:Brain Ischemia / Q000150:complications*; D019317:Evidence-Based Medicine / Q000331:legislation & jurisprudence; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007258:Informed Consent; D008318:Malpractice; D018579:Patient Selection; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator