tPA pro/con debate from EMcrit website


Dr. Andy Jagoda and Dr. Swaminathan debate the pros and cons of tPA for acute stroke.  Please vote in the poll below

tpa pro and con debate from EMcrit website


4 thoughts on “tPA pro/con debate from EMcrit website

  1. I myself fall on the con side of the debate. although I feel that tPA has the potential to be a great drug, I think that there should be multiple validation studies proving effectiveness, instead of one trial that has been data mined. why are there so many trials showing no benefit or harm to thrombolytics, yet there is an ACEP level A recommendation for giving tPA? I think if we get at least one or two good validation trials, I will change my mind into the Pro camp.

  2. So a quick comment on starting a blog and then I will comment on the debate. I think this is a great idea Neil! I find it so helpful and interesting to hear from my colleagues with regard to their clinical practice and general opinions on hot button topics. Thank you for setting this up.

    I also fall on the con side of this debate. Looking at the NINDS trial itself there seem to be a lot of flaws with it not limited to the fact that the placebo group had more severe strokes than those given TPA. I feel the drug has potential too but would also like to see more than 1 major trial showing benefit. I am not ready to embrace thought of it just yet as a ACEP level A recommendation.

  3. Keep in mind that anything in medicine (surgery, procedures, medications, even a simple admission to the hospital) comes along with significant risks, including a worse outcome than what we initially intended to treat. If after reading this post, you suddenly suffered a significant stroke with a disabling deficit that might be permanent, causing loss of career and independence, would you want something done or just have everyone wait and see?

  4. here’s another analysis about the data in case anyone is interested. this one is a little more in depth about the data. it’s from the SMART EM podcast by Dr. David Newman

    or if you prefer to read a nice summary of the literature, is a nice review of the literature analyzed. (this website is authored by Dr. David Newman, as well)

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