Stroke, tPA, and physician decision-making

They miss the point that tPA is basically a failure since only the 'right candidates' benefit. Not until we publicly call it a failure will there be a concerted effort to find something better and maybe go down the route of stopping the neuronal cascade of death.
http://www.neurology.org/content/81/13/e102.full

WHAT DID THE RESEARCHERS STUDY?

Intravenous tissue plasminogen activator (IV tPA) is a protein that is used to break up blood clots. A blood clot that forms in an artery can block the flow of blood “downstream.” Areas of brain that rely on the now-blocked blood vessel become starved for oxygen. When a part of the brain is starved for oxygen, it is called ischemia or a stroke. The area of brain where the stroke occurs determines the resultant neurologic problems. For instance, if the stroke occurs in a region of brain that controls movement, the person becomes weak.

When a stroke happens, the use of tPA can open the blood vessel and restore proper blood flow to the brain. Treatment with IV tPA can minimize the damage from a stroke by allowing blood and oxygen to reach its destination. Stroke is a common neurologic condition. It is estimated that stroke occurs in 2.5%–2.7% of people living in the United States or one of its colonies (data from 2006 to 2010: the Centers for Disease Control and Prevention¹). Surprisingly, fewer than 5% of patients with ischemic stroke receive treatment with IV tPA.²

Many factors may affect the use of tPA. For instance, tPA must be given within hours of the onset of the stroke. If a person did not immediately go to the hospital, he or she may not be able to receive tPA. Further, tPA may not be available at all hospitals. In addition, tPA cannot be given in certain medical conditions, limiting its use. Even when these factors are considered, the rate of administration of tPA is low. One factor that has not been carefully studied is the physician's decision-making process. It was because of this that Dr. Shamy and his colleagues examined the factors that influence physicians' decisions in treating acute stroke with IV tPA in “The complexities of acute stroke decision-making: A survey of neurologists.”³

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