BACKGROUND: Alteplase (tPA) is a United States (US) Food and Drug Administration-approved treatment for acute ischemic stroke, though there are significant barriers to thrombolytic use, including Emergency Physicians' (EPs') concern for level of supporting evidence. STUDY OBJECTIVES: To review the medical literature on the topic of acute cerebrovascular accident (CVA) management and to offer EPs evidence-based recommendations for patients who present to the Emergency Department with an acute CVA. METHODS: A MEDLINE literature search from 1990 to 2011 and limited to human studies written in English for articles with keywords of: CVA AND (thromboly* OR alteplase). Guideline statements and non-systematic reviews were excluded. Studies targeting differences between specific populations (males vs. females) were excluded. Studies identified then underwent a structured review from which results could be evaluated. RESULTS: There were 407 papers on thrombolytic use screened, and 15 appropriate articles were rigorously reviewed and recommendations given. CONCLUSIONS: tPA is an effective treatment for stroke when given in prepared stroke centers; EPs and hospitals treating stroke patients with tPA need to have the necessary resources in place and a specific plan for timely care of patients with acute stroke.
BACKGROUND: Alteplase (tPA) is a United States (US) Food and Drug Administration-approved treatment for acute ischemic stroke, though there are significant barriers to thrombolytic use, including Emergency Physicians' (EPs') concern for level of supporting evidence. STUDY OBJECTIVES: To review the medical literature on the topic of acute cerebrovascular accident (CVA) management and to offer EPs evidence-based recommendations for patients who present to the Emergency Department with an acute CVA. METHODS: A MEDLINE literature search from 1990 to 2011 and limited to human studies written in English for articles with keywords of: CVA AND (thromboly* OR alteplase). Guideline statements and non-systematic reviews were excluded. Studies targeting differences between specific populations (males vs. females) were excluded. Studies identified then underwent a structured review from which results could be evaluated. RESULTS: There were 407 papers on thrombolytic use screened, and 15 appropriate articles were rigorously reviewed and recommendations given. CONCLUSIONS:tPA is an effective treatment for stroke when given in prepared stroke centers; EPs and hospitals treating strokepatients with tPA need to have the necessary resources in place and a specific plan for timely care of patients with acute stroke.
Authors: Norberto L Cabral; Selma Franco; Alexandre Longo; Carla Moro; Talita A Buss; Daniel Collares; Roberta Werlich; Danieli D Dadan; Cristiane S Fissmer; Ana Aragão; Priscilla Ferst; Felipe G Palharini; Jose Eluf-Neto; Luiz A M Fonseca; William N Whiteley; Anderson R R Gonçalves Journal: Am J Public Health Date: 2012-10-18 Impact factor: 9.308