Discussion - tPA Stroke

We discussed risks, benefits and alternatives to tPA with the [patient/family] at this time.  We specifically discussed the results of the NINDS study which suggested that 8 out of 18 stroke patients who receive tPA according to a strict protocol will recover by 3 months after the event without significant disability.  We discussed that this is compared to 6 out of 18 stroke patients (one-third) who recover substantially regardless of treatment.

We discussed that tPA has potential risks, which include bleeding into the brain, other types of serious bleeding, and even death that vary by studies.  We discussed the following risks:

-The NINDS study suggested that bleeding into the brain occurred in about 1 out of 18 patients receiving tPA (specifically, 5.8%).  When this occurred, there was a 45% fatality rate.

-Several studies suggested treatment with “clot-dissolving” medications increases the number of patients who die following a stroke.

-Subsequent studies demonstrated that using tPA more liberally than is recommended in NINDS protocol resulted in a higher rate of intracranial hemorrhage.

We also discussed that tPA complications are more likely in patients over 70 years of age, those with more severe stroke (NIHSS over 15), or those with an elevated blood glucose (specifically >300 mg/dL).  After discussion of these risks, the [patient/family] wished to [be treated with tPA/refuse treatment with tPA].

https://www.aaem.org/UserFiles/file/tpaedtool-AAEM.pdf