All this brainpower and not one understands that delivering tPA faster is not the solution to reduced disability. Damn it all tPA has only a 12% efficacy and does nothing on stopping the neuronal cascade of death. This is so f*cking simple to prove. You do daily MRI scans to see the progression of the dead area during the first week. And maybe then these idiots will solve the correct problem.
tPA delivery times are not the problem to solve. Reducing neuronal cell death is the problem to solve.
http://www.medpagetoday.com/Neurology/Strokes/46455?
The last paragraphs here;
The outcomes in stroke patients -- even those who don't get
thrombolytics and, in fact, mostly in those who don't get thrombolytics
-- have improved. Outcomes have improved immensely for almost every
group over the last 10 to 12 years.
When you look at 2003 to 2010,
we know that stroke mortality has been going down. We know it's been
going down, partly because of epidemiologic trends that preceded the
advent of the drug, and partly because of high quality stroke unit care.
There is no reason to believe that these improvements have had anything
to do with thrombolytics.
So, it's a little bit strange to see the JAMA trumpeting this as a success and talking about it in ways both in an editorial and in the discussion sections of this study, that suggest thrombolytic administration minutes earlier is the reason that stroke mortality went down.
The two almost certainly have nothing to do with each other.
This
is probably, and sadly, another example of wishful thinking. We would
like to believe that thrombolytics could save lives but randomized
trials strongly contradict the idea. But we wish it was true, just like
we wish that getting the drugs on board earlier could improve outcomes.
In
the end, judging from the one marker that thrombolytics are supposed to
affect -- disability -- the drugs seem to have failed yet again.
Read the rest and weep because our doctors still have absolutely no idea on how to treat stroke.
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