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Episode Chapters

  1. Introduction2:23
  2. Ultra Summary26:04
  3. Rick’s Rants: The Cost of Getting Paid10:31
  4. Time To Talk A Little Nerdy: Odds Ratios, Relative Risk Etc14:59
  5. Reflections of a Skeptic: Critical Appraisal Of A Study - Part II: Bias25:08
  6. Then And Now: A Short History Of TPA For Stroke20:52
  7. Farewell1:05

Then And Now: A Short History Of TPA For Stroke

Mel Herbert, MD MBBS FAAEM, Jennifer Farah, MD, Rick Bukata, MD, Jerry Hoffman, MD, Mike Menchine, MD, and Sanjay Arora, MD
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20:52
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No me gusta!

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Mel and Jenny look back to 1996, when we first started using thrombolytic therapy for stroke. How has our approach to stroke management changed over the years?

References:

  • EMA 1996 November Abstract 12 | Thrombolytic Therapy With Streptokinase In Acute Ischemic Stroke The Multicenter Acute Stroke Trial - Europe Study Group N Engl J Med 335(3):145, July 18, 1996
  • EMA 1996 January Abstract 9 | Tissue Plasminogen Activator For Acute Ischemic Stroke The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group N Engl J Med 333(24):1581, December 14, 1995
  • EMA 2018 November Abstract 2 | Effect Of Alteplase vs Aspirin On Functional Outcome For Patients With Acute Ischemic Stroke And Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial Khatri, P., et al, JAMA 320(2):156, July 10, 2018

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Dr. Zuzu -

What a great review----Thanks.

Jonathan G. -

I heard a stroke neurologist who trained at the Cleveland Clinic brought up the following Points: When he trained (which was after NINDS) if a stroke patient improved after TPA they would say that the person had a TIA because NINDS did not show a measured improved clinical outcome within 24 hours. It only showed improved outcome at three months.

I see this quite a bit that patients will improve within 24 hours after receiving TPA and everyone, including neurologists will say "Look the patient got better because getting the TPA." I just think that is the wrong way to look at it. Have been trials that show benefit of TPA within 24 hours?

He also mentioned that this was a phase II trial and there should have been a phase III trial before TPA when mainstream.

Also I really enjoyed that hearing Rick and Jerry cover the article for the first time.

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