Breaking News: The ‘Biggest, Baddest’ Controversy in EM
SoRelle, Ruth MPH. Emergency Medicine News: April 2013 - Volume 35 - Issue 4 - pp 1,26–27 . doi: 10.1097/01.EEM.0000428925.65534.eb
SoRelle, Ruth MPH. Emergency Medicine News: April 2013 - Volume 35 - Issue 4 - pp 1,26–27 . doi: 10.1097/01.EEM.0000428925.65534.eb
"The American College of Emergency Physicians and the American Academy of Neurology jointly issued a new clinical policy on thrombolytics for stroke, but the new statement has done little to resolve one of the most troubling rifts in emergency medicine.
The recommendations are nothing new in thrombolytics-for-stroke circles, first
drawing attention after the original NINDS trial was published in 1995. (N
Engl J Med 1995;333[24]:1581.) The new guidelines, published in the
February issue of Annals of Emergency Medicine, stamp an A-level
recommendation on treating stroke patients who meet the NINDS criteria with tPA
within three hours of symptom onset. They also place a B recommendation on tPA
for stroke patients who meet the European Cooperative Acute Stroke Study (ECASS)
criteria for treatment between three and 4.5 hours after symptom onset.
(JAMA 1995;274[13]:1017.) An introduction to the new policy understates
the issue: “The use of IV tPA for stroke has been one of the most contentious
medical treatments.”
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Author: David Newman, MD. Published/Updated: August 25, 2010