Each year, an estimated 795,000 people have a stroke. Strokes are classified as either ischemic or hemorrhagic, with ischemic strokes afflicting 87% of those who suffer. Clots in vessels that lead to the brain cause an ischemic stroke and evidence has shown that quick recognition and treatment of this type of stroke is the most critical element in predicting long term outcomes. Since 1996, the FDA “gold standard” treatment for an ischemic stroke is tPA, or tissue plasminogen activator. This drug, given by IV within 3 (or sometimes 4.5) hours of the stroke’s onset, opens blocked blood vessels by dissolving the clot. Rapid treatment with tPA can prevent brain cell death caused by lack of blood flow to the brain. In other words, the drug has been shown to substantially decrease the neurological aftermath of a stroke. Both the American Heart Association and the American Stroke Association call for the use of tPA in patients who don’t have contraindications. Yet, almost 30% of all ischemic stroke patients are not given this drug.
Side Effects in Some Tainting Benefits for Others
tPA is certainly not for every stroke patient. The drug is only meant to be used in patients who arrived at the hospital within 3 hours of the onset of an ischemic stroke and have been cleared by a trained physician.
The drug is not for use in patients who have a variety of other conditions, including a hemorrhagic stroke, uncontrolled high blood pressure, suspected intracranial hemorrhage, suspected subarachnoid hemorrhage, head trauma, or a previous stroke within the last three months. The American Stroke Association reports that 6 in 100 patients cleared for tPA therapy develop more bleeding in the brain as a result of the drug and like with most drugs, the benefits should outweigh the potential risks. So why are so many stroke patients not receiving a drug that is endorsed by the American Stroke Association and American Heart Association, the preeminent voices in stroke and heart attack research, prevention, and treatment?
Dr. Christopher Lewandowski, an emergency room physician at Henry Ford Health System in Detroit, tells the New York Times that the drug has gotten a bad rap by a small group of doctors whom have used their influence to sway public opinion towards fear of using the drug. In fact, some older physicians report discussing the drug with younger doctors, many of whom act as if the drug is more harmful than helpful in all ischemic stroke patients.
Dr. Lewandowski has been a believer in the benefits of the drug for almost 22 years. It was then that he served as the lead of a federally-funded clinical study of tPA that found that the drug could help prevent brain cell death in ischemic stroke patients. He felt the data was hard to dispute and for the most part, physicians who treat stroke patients agree. However, one doctor who didn’t agree with Lewandowski has made an impact on his own life. For Dr. Lewandowski, publicly voicing the benefits of the drug is personal. 10 years ago, his own father had a stroke. From hundreds of miles away, Lewandowski advised his mother to tell the doctor treating his father that he wanted tPA to be given. The doctor wouldn’t do it, something Lewandowski believes caused his father to suffer for the years before his death with right side paralysis, speech problems, and facial droop.
Study Finds Doctors Use Faulty Reasoning for Ruling Out tPA Use
A 2016 study led by Steven Messe, M.D., an Associate Professor of Neurology at the Hospital of the University of Pennsylvania found that of stroke patients, women, minorities, and older patients were all less likely to be given tPA, even in the absence of contraindications. They also found striking evidence that stroke patients whose symptoms were reported to have improved quickly were less likely to receive tPA, even though study after after study has proven that this often leads to a poor prognosis in the long term. Study authors found this reason for not given tPA marked in more than 50% of the medical records in the study, which included 177,719 stroke patients who met the criteria for receiving tPA.
The takeaway is that tPA should be considered when all factors ruling out their use have been evaluated by a trained physician. A patient or patient’s loved one should always be given their options and allowed to weigh the risks and benefits of any medical treatment or drug. If you have a loved one who has died or is suffering neurological trauma as a result of a stroke and they were not given the option to receive tPA, you may have cause for legal action. The Chicago medical malpractice attorneys of Levin & Perconti have a track record of success in resolving cases in which patients were not given a voice in their own medical care. Consultation are always free. Please call us now at 312-332-2872 or fill out our online case evaluation form.