tPA in wonderland

The last few years have been a whirlwind for lytics in stroke.

What started out as the promised land has morphed into a veritable amazon forest. Whilst most agree with the basics and principles of it but the results have been far from convincing. Throw in some "fudgy" trial results with drug company sponsors and there is no wonder you have a growing skeptical audience.

There are trials and studies abound in every country but I personally don't push the "snake venom" to patients who are older than 80. Most of my learned colleagues on this site and I think of reasons NOT to give tPA rather than to give. Our take:

  • Talk to your patients
  • Talk to your patients' families
  • They ned to to know NNH as well as NNT
  • Show them simple diagrams to understand the above sentence like this one

Here's a fantastic PREZI look into the history of the relevant research:


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