Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape

 The real solution to this is reducing the size of the bolus subtantially.

You mean stroke leadership completely fucking failed at putting together magnetic nanoparticles delivering smaller loads of tPA resulting in much less chance of bleeds? Solving doctor reluctance.

We should have been using magnetic nanoparticles to deliver tPA for years.

Maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

Or this from  May, 2012

Future of med devices: Nanorobots in your blood stream

The latest here:

Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape

Latha Ganti MD, MBA, Bryan Kwon, Andrew George, Thor Stead ScB, Cherian Plamoottil DO, Paul Banerjee DO

First published: 22 January 2022

https://doi.org/10.1002/emp2.12646

Prior presentation: American College of Emergency Physicians Research Forum, October 2021, Boston, MA.

Funding and support: : By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.

Supervising Editor: Marna Rayl Greenberg, DO, MPH.

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Abstract

Objective

Tissue plasminogen activator (tPA) is considered standard of care for acute ischemic stroke treatment, but some physicians withhold or delay this highly time-dependent therapy from stroke patients because they do not think it works well or they are worried about the adverse effects or fear medico-legal consequences. The authors sought to investigate whether litigation arises from physicians treating versus not treating acute ischemic stroke patients with tPA.

Methods

The authors examined closed cases from 1996 to 2020 in an online legal database, Westlaw, regarding alleged complaints for whether or not thrombolytic treatment was given for acute stroke.

Results

Sixty-six relevant cases were identified. In all 66 cases, the plaintiffs sued for issues stemming from either failure to give tPA or a delay in giving tPA. In 77% of cases the verdict was in favor of the defendant. Only 1 lawsuit included intracerebral hemorrhage after tPA, but it was brought forth owing to delay in giving tPA; the verdict was in favor of the defendant.

Conclusion

It is more common for patients to sue physicians for not administering tPA in a timely fashion or at any point. Medicolegal risks of withholding or delaying tPA are clear, whereas we found no clear medicolegal risk to providing tPA when indicated.