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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, November 1, 2019

tPA in Stroke Mimics

REBEL Cast Ep72 - October 30, 2019 - By Salim Rezaie
"Author Conclusion: “In this large cohort of patients treated with tPA, relatively few patients who received tPA for presumed stroke were ultimately not diagnosed with a stroke or transient ischemic attack. The complication rates associated with tPA in stroke mimics were low. Despite the potential risk of administering tPA to stroke mimics, opportunity remains for continued improvement in the rapid and accurate diagnosis and treatment of ischemic stroke.” 
Clinical Take Home Point: We disagree with these authors conclusions that state the complication rates associated with alteplase in stroke mimics were low. Reporting bias (not all stroke mimic cases reported), selection bias (exclusion of smaller hospitals with lesser patient volumes), and rates of increasing alteplase administration all lend themselves to gross underestimation of harms of alteplase in stroke mimics in patients who have zero chance of benefit from this medication. Furthermore, stroke care should be moving to a perfusion-based paradigm and away from a time is brain paradigm which has consistently been replicated in endovascular studies in acute ischemic stroke."