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May 2017 - Hotpocket

Mel Herbert, MD MBBS FAAEM and Rob Orman, MD
00:00
14:13
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No me gusta!

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Our recent segments on stoke updates and naloxone dosing have set off a storm of controversy!

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Ian L., Dr -

For the Primary care doctor there is Cochrane Wardley et al July 2014 that recommends IV TPA within 3 hours more so from trials the majority of which were government or charity funded .
Cochrane is regarded as a hard taskmaster I believe .
So the challange is to stratify those patients in which IV TPA will more likely lead to disaster .
I would be interested in the Panel analyses .

Ian L., Dr -

Futher reading of the research reveals as regards IV tpa success the thrombin permeality of the clot and this permeability can be measured and the length of the clot in the middle cerebral artery 2-10mm relates to success in attempting to dissolve clot .
So the statement IV TPA just cannot dissolve clot is not always true it may depend depend on clot density and length of clot .
For Permeable Thrombi the reference is Santos et al Stroke 2016 August : in " pervious"Thrombi strokes complete recanalisation achieved more frequently than conservative therapy opening in this trial stratification criteria if validated.
Stratification based on site of thrombus and length of thrombus is in a paper by Seners et al Stroke 2016 September 2409-12 and other trials are upcoming .

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May 2017 - Hotpocket Full episode audio for MD edition 14:13 min - 12 MB - M4A