BONUS - Headache Guidelines - TPA for Stroke

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Andrew R., M.D. -

Just a few questions for Dr Edlow regarding this very controversial topic of TPA for strokes. What exactly happened during this past 1-2 yrs to prompt ACEP's change to support TPA? Although I hate to read the medical literature, I listen to each EMA and EmRAP tape twice, and the only new studies I'm aware of is ECASS 3 which hardly seems like a strong enough study to change ACEP's stance (especially when one wonders about the unpublished but implied ECASS 1 & 2). Or perhaps Dr Edlow's committee finally got a chance to view the actual data from NINDS as Drs Hoffman and Schriger did years ago, but came up with the opposite conclusion?
Two, why wasn't Dr Hoffman involved in the ACEP TPA discussion? He's obviously the most outspoken physician on this subject, and his credentials are respected even in the lay press. See BusinessWeek 1/16/08 article regarding statins. It is not a cardiologist, nor an internist they interview but rather an EM doctor.
Lastly, since the first two questions are so glaring, I was wondering if Dr Edlow had any financial disclosures to make? I doubt he does as you have done a very good job avoiding interviews with such physicians. The only one I vaguely recall regarded psychiatric clearances a few years ago. I hope you continue to avoid such conflicts.

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