tPA in CVA

Started by roja
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roja

roja

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7+ Year Member
15+ Year Member
I am hoping that *someone* is anal about keeping all pieces of papers from confences like ACEP and has been to the Bukata/Hoffman literature reviews (or has a subscription to thier reviews!)

Last years ACEP (in SF) encompassed a lit review on tPA and CVA. Bukata/Hoffman cited several good articles, including a rather obscure, but impressive, article against lysis.

I am killing myself trying to find the references.

(We went to a nueroICU conference today where all presentations where PRO lysis.. I am trying to find literature to support the other side as well for my fellow residents....)


Can anyone help?????
 
roja said:
I am hoping that *someone* is anal about keeping all pieces of papers from confences like ACEP and has been to the Bukata/Hoffman literature reviews (or has a subscription to thier reviews!)

Last years ACEP (in SF) encompassed a lit review on tPA and CVA. Bukata/Hoffman cited several good articles, including a rather obscure, but impressive, article against lysis.

I am killing myself trying to find the references.

(We went to a nueroICU conference today where all presentations where PRO lysis.. I am trying to find literature to support the other side as well for my fellow residents....)


Can anyone help?????
Click to expand...

Are you talking about the ECASS trials of streptokinase or one of the other 6 hour trials? Perhaps the Cleveland experience? Sorry I can't give you the references, but they should be easy to search. I've got a powerpoint from journal club last year at the office on this. PM or email me if you want it.

The bad news for the "antis' is that I haven't seen ANY valid stuff against the NINDS criteria. Rather the articles cited against show that:

1. If you can't read a CT you probably shouldn't do it and
2. If you can't follow instructions, particularly about the time limits you shouldn't do it.
3. You've got to use the smaller dose of TPA specified.

But for that rare stroke patient meeting all of the inclusion criteria and having no exclusions, the NINDS trial strongly supports treatment. That will only be about 1 in 20 ischemic strokes. Recommend you set this up with your neuro and radiologists in advance.
 
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