Archives for May 3, 2005

Stroke drug side effects limit use

Emergency Medicine isn’t sold on TPA for stroke: Stroke drug side effects limit use.

Stroke drug side effects limit use

Ann Arbor, MI, May. 2 (UPI) — The only drug approved to treat stroke victims is not used by all U.S. emergency physicians because of concerns about side-effects, a Michigan study found.

The drug, called rt-PA, carries a 6.4 percent risk of a brain hemorrhage  in stroke victims, a concern that causes about a quarter of emergency room physicians to avoid using it, according to University of Michigan Health System researchers.

The study, published Monday in the Annals of Emergency Medicine, found emergency physicians were more likely to use the drug on heart attack patients, who have a 1 percent risk of brain hemorrhage.

It’s also called the "Walk or Die" therapy, as some of those treated can get a lot better or very very much worse.  I don’t know any ER doc who is happy about the whole ‘TPA for CVA’ idea.  There was a big push to TPA strokes after the first study (by NINDS, done by the NIH).  To the best of my knowledge, there have been studies that tried to replicate the NINDS results, and none have been able to get the same good outcome ratio of the original study.

This application for TPA crosses my ‘First Do No Harm’ line.  It’s a drug that may have an (unpredictable) upside, but has a huge downside in stroke.  To me, the definitive study of who, and when (and where) for TPA in stroke has yet to be done.