A 75-year old man comes to your Emergency Department with an acute onset of left sided weakness and a facial droop.
His NIH Stroke scale is 15.
A stroke alert is called and the stroke fellow and her team race-walks to the Emergency Department. A vigorous discussion of whether to give tPA (alteplase) as a treatment for acute ischemic stroke.
It is high noon.
1. If onset was clearly witnessed at 10am, what does ACEP’s previous (rescinded) 2012 clinical policy state should occur? And if enacted, what would the new proposed 2014 ACEP clinical policy state should occur?
2. What if onset had instead been 8am? What does ACEP’s previous (rescinded) 2012 clinical policy state should occur? And if enacted, what would the new proposed 2014 ACEP clinical policy state should occur?
Here is a handy figure by Dr. Lauren Westafer (@LWestafer) that summarizes the key differences in the rescinded 2012 ACEP Clinical Policy on tPA for Acute Ischemic Stroke and the proposed 2014 draft. For more, listen to a new special episdode of FOAMcast covering what you need to know about this hot topic. (www.foamcast.org, @FOAMpodcast). Here’s the episode:
All of these patients may or may not be candidates for tPA with the goal of improving functional outcomes in acute ischemic stroke. The question remains, who will benefit? Further studies are needed!
Resources:
New ACEP clinical policy draft: Tpa for Stroke Draft 1-5-15
Rescinded 2012 ACEP clinical policy: Tpa Clinical Policy-5
Where to comment on the current draft between now and March 13, 2015:
http://www.acep.org/Clinical-Policy-Comment-form-Intravenous-tPA/?_cldee=anNmYXVzdEBnbWFpbC5jb20%3d
More resources and links to other posts on www.Foamcast.org
Thoughts? Comments? Tweet at @SinaiEM, @JeremyFaust, @LWestafer or, @FOAMpodcast!
