Well shit it has been known for years that
tPA doesn't fully work most of the time. But is there a rallying cry to find a replacement? I have heard nothing because no one wants to address any of the
fucking problems in stroke. All the stroke associations have got their heads so far up their asses they will never see any problems. And this is even written by the World Stroke Organization. I can guarantee you they will do nothing.
http://www.ncbi.nlm.nih.gov/pubmed/22264226
Abstract
BACKGROUND:
Acute
administration of tissue plasminogen activator has been shown to
improve immediate and long-term patient recovery after ischaemic stroke.
Yet, despite widespread clinical application, many patients who receive
acute tissue plasminogen activator still require inpatient
rehabilitation.
AIMS AND HYPOTHESIS:
This
study aimed to examine the effect of tissue plasminogen activator
administration on recovery among patients requiring inpatient
rehabilitation after stroke in Ontario, Canada. It was hypothesized that
after covariate adjustment, administration of tissue plasminogen
activator would be associated with accelerated progress through
inpatient rehabilitation.
METHODS:
Acute
and rehabilitation data were retrieved from the Registry of the
Canadian Stroke Network and the National Rehabilitation Reporting System
for all ischaemic stroke patients admitted to an acute facility and a
rehabilitation unit between July 1, 2003 and March 31, 2008. Patients
were divided into two groups: those who received tissue plasminogen
activator and those who were medically eligible but did not receive
tissue plasminogen activator. Three rehabilitation progress indicators
were compared between groups: Functional Independence Measure gain,
active length of stay, and discharge destination. Indicators were
modelled using multivariable generalized linear models or logistic
regression as appropriate.
RESULTS:
Patients
who received tissue plasminogen activator experienced shorter active
lengths of stay (log estimate ± standard error: -0·04 ± 0·01 days), and
were slightly more likely to be discharged home compared to controls
(adjusted odds ratio 1·35, 95% confidence interval 1·004-1·82). No
differences were noted on Functional Independence Measure gain during
rehabilitation.
CONCLUSION:
Results
suggest that tissue plasminogen activator may contribute to accelerated
progress through inpatient rehabilitation; however, there is no
evidence to suggest that it contributes to greater functional
improvement as measured by the Functional Independence Measure.
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