Background and Purpose:
Although
neurologists consider intravenous tissue plasminogen activator (tPA) to
be
standard of care in the treatment of patients with acute ischemic
stroke, its use remains contentious within the broader medical
community, and particularly among emergency physicians. Why might this
be? We provide a historical context to this ongoing controversy by
reviewing how neurologists have conceptualized the acute stroke and its
treatment, with the aim of bridging this gap.
Methods:
Based
on historical sources in the Mackie Family History of Neuroscience
Collection at the University of Calgary, as well as online resources, we
trace the evolution of the concept of the “acute stroke,” which has
come to mean a stroke that is potentially treatable with tPA. We frame
this conceptualization in relation to historical “building blocks” in
anatomy, pathology, and physiology. We then use these building blocks to
explain why neurologists understand tPA to be effective and why
emergency physicians often do not.
Results and Conclusions:
Arguments
against the use of tPA reiterate 20-year-old concerns about its
efficacy and safety. We believe these persistent concerns can be framed
as a lack of understanding of the “building blocks” upon which
neurologists’ conception of tPA is built. Our view suggests that the way
forward to bridge the gap between neurology and other disciplines is
not to conduct more trials but to offer a shared conceptualization of
the trials already completed and of the intellectual tradition from
which they emerged.
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