Utilization of Intravenous Tissue Plasminogen Activator for Ischemic Stroke: Are There Sex Differences?

2009 ◽  
Vol 27 (3) ◽  
pp. 254-258 ◽  
Author(s):  
Norrina B. Allen ◽  
Daniela Myers ◽  
Emi Watanabe ◽  
Jackie Dostal ◽  
Danny Sama ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

scholarly journals Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke

Stroke ◽  
1998 ◽  
Vol 29 (1) ◽  
pp. 18-22 ◽  
Author(s):  
David Chiu ◽  
Derk Krieger ◽  
Carlos Villar-Cordova ◽  
Scott E. Kasner ◽  
Lewis B. Morgenstern ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Abstract WP280: Use of Strategies to Improve Door-to-Needle Times with Tissue Plasminogen Activator in Acute Ischemic Stroke by US Hospitals: Findings from the Target: Stroke Survey

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Gregg C Fonarow ◽  
Eric E Smith ◽  
Xin Zhao ◽  
Eric D Peterson ◽  
Ying Xian ◽  
...  
Keyword(s):  
Emergency Department ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Stroke Care ◽  
Ct Scanner ◽  
Critical Pathways ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background: The benefits of intravenous tissue-plasminogen activator (tPA) in acute ischemic stroke are time-dependent and several strategies have been reported to be associated with more rapid door-to-needle (DTN) times. However, the extent to which hospitals are utilizing these strategies has not been well studied. Methods: We surveyed 304 hospitals joining Target: Stroke regarding their baseline use of strategies to reduce door-to-needle times in the 1/2008-2/2010 timeframe (prior to the initiation of Target: Stroke). The survey was developed based on literature review and expert consensus for strategies identified as being associated with shorter DTN times and further refined after pilot testing. Categorical responses are reported as frequencies. Results: Hospitals participating in the survey were 50% academic, median 163 (IQR 106-247) ischemic stroke admissions per year, median 10 (IQR 6-17) tPA treated patients per year, and had median 79 minute (IQR 71-89) DTN times. By survey, 214 of 304 hospitals (70%) reported initiating or revising strategies to reduce DTN times in the prior 2 years. Reported use of the different strategies varied in frequency, with use of ischemic stroke critical pathways, CT scanner located in the Emergency Department, and tPA being stored in the Emergency Department being the strategies least frequently employed (Table). As part of Target: Stroke participation, 279 of 304 hospitals (91.5%) indicated they planned to have a dedicated team focused on reducing DTN times. Conclusions: While most US hospitals participating in this survey report use of the strategies to improve the timeliness of tPA administration for acute ischemic stroke, significant variation exists. Further research is needed to understand which of these strategies are most effective in improving acute ischemic stroke care.

scholarly journals Medicolegal Considerations with Intravenous Tissue Plasminogen Activator in Stroke: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Archit Bhatt ◽  
Adnan Safdar ◽  
Dhara Chaudhari ◽  
Diane Clark ◽  
Amber Pollak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Malpractice Litigation ◽  
Extensive Search ◽  
Intravenous Tissue Plasminogen Activator ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background.Intravenous tPA (tissue plasminogen activator) therapy remains underutilized in patients with Acute Ischemic Stroke (AIS). Anecdotal data indicates that physicians are increasingly liable for administering and for failure to administer tPA.Methods.An extensive search of Medline, Embase, Westlaw, LexisNexis Legal, and Google Scholar databases was performed. Case studies that involved malpractice litigation in ischemic stroke and thrombolytic therapy were analyzed systematically.Results.We identified 789 ischemic stroke litigation cases, of which 46 cases were related to intravenous tPA and stroke litigation. Case descriptions of 40 cases were available. Data for verdicts were available for 38 patients. The most frequent plaintiff claim was related to failure to administer intravenous tPA (38, 95%). Only 2 (5.0%) claim involved complications of treatment with tPA. Hospitals were defendants in majority of the 36 cases. Physicians were involved in 33 cases. While ED physicians were involved in 25 (60.52%) cases, neurologists were involved in 8 (20.0%) cases. There were 26 (65%) defendant-favored and 12 (30%) plaintiff-favored verdicts.Conclusion.Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred.

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