ER Doctors Can Use Thrombolytics on Stroke Victims

A study has found that emergency room (ER) doctors can deliver thrombolytic drugs to appropriate stroke patients as quickly and safely as dedicated stroke teams if they follow the recommended guidelines. The study was presented at the annual meeting of the Society for Academic Emergency Medicine in St. Louis (MO, USA).

The thrombolytic drug called tissue plasminogen activator (tPA) can break up a clot and reduce the risk of brain damage in stroke victims if the stroke is caused by a clot and not by an intracranial hemorrhage and if the drug is administered within three hours after occurrence. However, many emergency doctors hesitate to use tPA, fearing they cannot achieve the same results as stroke teams and not wanting to risk the potential liability if treatment that may cause a patient to hemorrhage.

In the study, researchers from the University of Michigan Health System (UMHS, Ann Arbor, USA) reviewed data on 140 patients treated with tPA by ER doctors at community and teaching hospitals. All the hospitals used acute stroke treatment guidelines. The rate of intracranial hemorrhage was 7%, the same as in prior studies of tPA used by dedicated stroke teams. Guidelines for stroke treatment are available at www.stroke-site.org/guidelines/guidelines.html.

"In 65% of the patients in our study, the ER doctor consulted with a neurologist before giving tPA, and half of those consultations took place over the phone,” noted Phillip Scott, M.D., director of the UMHS emergency stroke team and assistant professor in the department of emergency medicine. "Making the decision about stroke diagnosis and tPA treatment can be difficult, but with the proper support an ER doctor can do it with confidence.”

Another problem, say the researchers, is that many patients do not get to the ER in time for tPA treatment. In the study, on average, it took an hour from the time the stroke occurred until the victim reached the ER.




Related Links:
University of Michigan Health System
Stroke guidelines