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Stroke drug still meets resistance from doctors wary of its risks

ANN ARBOR, Mich. -- Forty percent of emergency physicians say they're unlikely to give stroke patients the only FDA-approved drug shown to improve their prognosis, even in an ideal setting, mostly because of the fear of causing brain bleeding.

But the majority of the doctors surveyed said that if they had appropriate backup from neurologists and a brain scanner available to help them diagnose and treat appropriate patients, they'd give the drug, called tPA. And if the risk of bleeding associated with tPA could be reduced, more physicians said they'd use it.

The findings are from a newly published survey of 1,105 emergency physicians conducted by University of Michigan Stroke Program researchers and published early online in the Annals of Emergency Medicine. The authors say it shows there's still controversy over the use of tPA, or tissue plasminogen activator -- and a long way to go to improve access to the therapy.

The authors also emphasize that safe and appropriate use of tPA should involve team-based approaches, where neurologists, radiologists and other specialists work with emergency physicians to diagnose stroke and choose the best treatment.

In fact, the authors predict that tPA use will increase as hospitals increasingly form stroke teams and write plans for what to do when a stroke patient comes through the emergency department door. Primary Stroke Centers are now recognized by the main hospital accreditation organization, JCAHO; U-M is one of the nation's 113 centers certified so far.

"This survey shows that there's still major resistance to tPA use in the emergency medicine community, but we shouldn't blame ED physicians or ask them to handle this decision alone," says lead author Devin Brown, M.D., a U-M stroke neurologist. "Only through team decision-making will we be able to change current practice and improve acute stroke care delivery."

Used within the first three hours of a stroke's onset, tPA can
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Contact: Kara Gavin
kegavin@umich.edu
734-764-2220
University of Michigan Health System
5-May-2005


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