Tuesday, November 12, 2013

Stroke, tPA and physician decision-making

A brief but thought-provoking article in the Neurology journal spells out recent survey results about the use of tissue plasminogen activator, the clot-busting drug used to treat certain stroke patients.

When is it right, when is it wrong, to apply the medication? Not in the cold scientific sense, but in the practical and ethical sense? If the patient would face devastating effects of the stroke no matter what? If the patient is in the throes of incurable dementia, such as Alzheimer's?

A snippet of the Stroke, tPA and physician decision-making article:
Studies like this one help to highlight and clarify the rationale behind the treatment of acute stroke. They allow us to understand the individual approaches that different physicians take to identical clinical problems. This study suggests that neurologists' decisions about tPA are based on many factors. Some of these factors include their own opinions about the quality of life a person might have after a severe stroke. For instance, Dr. Shamy discovered that most of the surveyed neurologists were less likely to give tPA to patients with dementia (like Alzheimer disease). This is in contrast to recent studies that have shown that there is no greater risk to tPA in people with dementia. Further supporting this finding was the observation that the physicians were less likely to treat patients with more severe strokes or those who might require assisted living.
Interesting results, interesting reading about decisions people face every day.

(Image from the National Institute of Neurological Disorders and Stroke)

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