This post is just a set of links to the evidence base of thrombolysis in stroke. The two that I got started with were:
- Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1 from Journal Jam of Emergency Medicine Cases July 2016
- Podcast 116 – the tPA for Ischemic Stroke Debate January 27, 2014 from EMCrit.
Here is the most recent ACEP guidelines on thrombolysis in stroke:
Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department [PubMed Abstract] [Full Text HTML] [Full Text PDF]. Ann Emerg Med. 2015 Sep;66(3):322-333.e31. doi: 10.1016/j.annemergmed.2015.06.031.
The podcast, Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1 [Link is to the podcast and shownotes], is outstanding. It is an 1 1/2 hours long and worth every minute. Here is the introduction:
In this 2 part EM Cases Journal Jam podcast Justin Morgenstern, Rory Spiegel and Anton Helman do a deep dive into the world’s literature on systemic thrombolysis for ischemic stroke followed by an analysis of endovascular therapy for stroke. We elucidate the important issues related to p-values, ordinal analysis, fragility index, heterogeneity of studies, stopping trials early and conflicts of interest related to this body of evidence. While “calling a code stroke” is now considered standard for most stroke patients and tPA for stroke is considered a class 1A drug, a close look at the literature tells us that the evidence is not as strong as our stroke protocols suggest…
And after listening to the podcast and reviewing the shownotes be sure and go to the end of the shownotes [after the references] and read Dr. Jim Siegler’s thoughtful critique of the podcast.
Dr. Siegler is editor-in-chief of BrainWaves – Continuing medical audiocation for neurologists and trainees; a podcast for neurology education.
And then, after carefully considering Dr. Siegler’s comments, review Dr. Morganstern’s response to Dr. Siegler’s comments.
And there is a 2014 Cochrane Database Review on Thrombolysis For Acute Ischemic Stroke that should be read.
Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke
And finally the shownotes of Journal Jam 10 Thrombolysis & Endovascular Therapy for Stroke Part 1 contain some links to FOAMed resources on the evidence base of thrombolysis in stroke.