I wonder about the contraindication of tPA use in the last 3 months? I know I wasn't asked if I was taking aspirin or anything else.
Whom is going to decide if this is enough information to change the
stroke protocol on this use? And then disseminate this to all stroke
doctors, emergency rooms and stroke hospitals?
WHO IS GOING TO DO THIS?
Our fucking failures of stroke associations obviously will not take on
this challenge. You as a stroke patient are simply screwed. YOU will need to remember this and notify your emergency room doctors.
http://medicalresearch.com/stroke/benefits-of-tps-outweigh-risks-in-ischemia-stroke-even-in-patients-on-antiplatelet-medications/19164/
MedicalResearch.com Interview with:
Ying Xian, PhD
Assistant Professor of Medicine.
Member in the Duke Clinical Research Institute
Medical Research: What is the background for this study? What are the main findings?
Dr. Xian: Intravenous
tissue plasminogen activator (tPA) is the only FDA approved medical
therapy to reduce disability and improve outcomes for patients with
acute ischemic stroke. But treatment with tPA also carries the risk of
symptomatic intracranial hemorrhage (sICH), which is often fatal. Nearly
half of ischemic stroke patients are taking antiplatelet drugs such as
aspirin and/or clopidogrel prior to stroke. We found these patients had
higher risk for sICH when treated with tPA. But the risk is relatively
small. For every 147 patients on aspirin treated with tPA, only 1 more
symptomatic intracranial hemorrhage as compared with those treated with tPA
without prior antiplatelet therapy. The risk is slightly higher among
those on dual antiplatelet therapy of aspirin and clopidogrel (number
needed to harm 60). Despite the higher bleeding risk, patients treated
with tPA on prior antiplatelet therapy appeared to have better
functional outcomes in terms of ambulatory status and modified Rankin
scale than those not on prior antiplatelet therapy. Therefore, overall
the benefits of thrombolytic therapy may outweigh the risks.
Medical Research: What should clinicians and patients take away from your report?
Dr. Xian: Considering intravenous tPA
is the only FDA approved medical therapy and remains substantially
underused worldwide for patients with acute ischemic stroke, clinicians
should consider intravenous tPA for eligible patients on prior
antiplatelet therapy. I would like to quote from Dr. Mark Alberts, Vice
Chair of Clinical Affairs in the Department of Neurology and
Neurotherapeutics at UT Southwestern Medical Center, “the real risk is
not treating.”
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Xian: As more potent P2Y12 inhibitors such as prasugrel
and ticagrelor are increasingly used in the Unites States, future
research is needed provide guidance on tPA for patients who developed
ischemic stroke while taking these new antiplatelet drugs.
Citation:
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