I'm reading the book tPA for Stroke: The Story of a Controversial Drug* about the clot busting drug that's used in "block" (ischemic) strokes. It was published in 2011.
The book tells the long, winding, political, and controversial path tissue plasminogen activator (tPA) took to get to market, and then be—somewhat at least—accepted as a treatment for ischemic (block) strokes. Is TPA still controversial? For some reason, yes.
Interesting Facts About TPA
•A study by the American Heart
Association looked at data from 300,000+
ischemic stroke patients, TPA was administered to 3.3% of patients.
⇒2.2% of patients at regular
hospitals got tPA
⇒6.7% at hospitals with PrimaryStroke Center Certification.
⇒Survivors are three times more
likely to get tPA if at a certified stroke center.
•In 2019 the journal Stroke did a review
of malpractice suits relating to treatment of stroke in hospitals
⇒Almost 30% of the cases were failure
to treat with tPA.
⇒The average payout for pre-trail
settlements was $1.8m. The average payout for court verdicts was almost $10m.
•A 2020 article in the Journal
of the American Academy of Neurology found “Overall, about
one-quarter of eligible patients with AIS (‘block stroke’) presenting within 2
hours of stroke onset failed to receive tPA treatment.”
⇒The article points out that women
and minorities are undertreated with tPA because of course they are.
•Speaking of women: Another 2020 article in the Journal of the American Academy of Neurology found…
⇒Compared to men, women were 30% less
likely get tPA.
⇒Sidenote: Women are also less likely
to receive aggressive treatment when it comes to heart attack.
•Weird Science: tPA is never
safe for hemorrhagic strokes. Except sometimes.
⇒There
are multiple studies (1, 2, 3)
showing that tPA can be used to increase longevity, decrease incrainial
pressure (pressure on the brain inside the skull), and reduce injury to neurons
from hydrocephaly (brain swelling). Note: t-PA in "bleed" stroke
shows efficacy in ongoing clinical trials, not yet in clinical
practice. The data we're waiting on is from the CLEAR
III trial.
•Can tPA be given for a second stroke? Yes! About
25% of survivors will have a second stroke. So its important to know two
things:
⇒You
should know the FAST test. Better yet, know A better version of the test.
⇒tPA is safe and just
as effective for a second stroke. Or, if you want it more science-y: "Repeated
use of IV-tPA was not associated with an increased risk of intracerebral
hemorrhage or death in patients with recurrent acute ischemic stroke."
•Is tPA effective and safe if you're over 80? Yes!
*The author, Justin Allen Zivin, MD, Ph.D., passed away in 2018 at age 71. He dedicated his career to identifying treatments for stroke, specifically the use of tissue plasminogen activator, or tPA... He encouraged the National Institute of Neurological Disorders and Stroke to change the paradigm for clinical stroke research, organizing a study that required a complete rethinking of how stroke care is managed.
This book was co-authored by John Galbraith Simmons.
