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I don't really think that's aphasia so much as the recent immigrant not knowing that the english word for the picture you're showing him is "hammock"...
tPA is a safe and effective drug with essentially no side effects of any importance. It should be offered to everyone who doesn’t have an intracranial hemorrhage on CT scan regardless of symptoms.
Sounds my stroke/sepsis coordinator talking.tPA is a safe and effective drug with essentially no side effects of any importance. It should be offered to everyone who doesn’t have an intracranial hemorrhage on CT scan regardless of symptoms.
You haven't lived until you've given alteplase to a drunk 90 year old who had some word finding difficulty at lunch that is no longer present.
tPA is a safe and effective drug with essentially no side effects of any importance. It should be offered to everyone who doesn’t have an intracranial hemorrhage on CT scan regardless of symptoms.
Anyone read the recent NEJM article on tPA for wake-up strokes? Pts had MRI to confirm recency of stroke, or more accurately ischemia amenable to intervention (wish they had used CT perfusion scan, as well, since this is the more common perfusion imaging across the country). Primary outcome of good neuro outcome (mRS 0-1) was 53% vs 42% (tPA vs placebo). Death was 4.2% vs 1.2% (not technically statistically significant). ICH 2% vs 0.4% (again not significant).
I think this definitively demonstrates improved neurological outcomes w/ tPA when strict inclusion and exclusion criteria are adhered to. It also less definitively demonstrates what we already know, that more people die w/ tPA. There doesn’t appear to be any statistical gymnastics. The only issue is that they cut the trial short by 300 patients.
NEJM - Error
Hey, you got to stop these trials before the numbers force you to say "statistically significant increased risk of mortality."Yeah, but cutting a trial short and then blowing off a three-fold mortality difference as "non-significant" is awfully suspicious.
They wanted 800, they got roughly 500. The “patients planned for but not enrolled in the trial” group was bigger than either the intervention or placebo group.Hey, you got to stop these trials before the numbers force you to say "statistically significant increased risk of mortality."
It's the best treatment for TIA.They wanted 800, they got roughly 500. The “patients planned for but not enrolled in the trial” group was bigger than either the intervention or placebo group.
Honestly, as we treat smaller and smaller deficits, tPA is going to continue to look better and better. As a miracle worker in severe strokes it clearly doesn’t work. As a mostly harmless adjunct to convert minor strokes, unresolved TIAs, and stroke mimics into lucrative short stay ICU admits it works well.
Hey, you got to stop these trials before the numbers force you to say "statistically significant increased risk of mortality."
We were going to give it to a patient with signs of left MCA stroke. He was young, but strangely kept refusing it. Turns out he had used cocaine just PTA, and as soon as it wore off, his neuro deficits disappeared.
Did you get an angiogram?