BrainWaves #61 Is tPA dead?

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021.

Originally released: July 18, 2017

With the advent of mechanical thrombectomy, some have argued that using intravenous tissue plasminogen activator for stroke is futile. But is it really? Dr. Sheryl Martin-Schild of Dr. Brain, Inc. joins us for today's episode to discuss whether the thrombectomy has killed tPA.

The content in this episode was vetted and approved by Sheryl Martin-Schild. Produced by James E Siegler. Music by Lee Rosevere, Josh Woodward, Kevin McLeod, and Little Glass Men. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making.

REFERENCES

Coutinho JM, Liebeskind DS, Slater LA, et al. Combined intravenous thrombolysis and thrombectomy vs thrombectomy alone for acute ischemic stroke: a pooled analysis of the SWIFT and STAR Studies. JAMA Neurol 2017;74(3):268-74. PMID 28097310

Demaerschalk BM, Kleindorfer DO, Adeoye OM, et al. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals From the American Heart Association/American Stroke Association. Stroke 2016;47(2):581-641. Erratum in: Stroke 2016;47(11):e262. PMID 26696642

Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 2016;387(10029):1723-31. PMID 26898852

Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995;274(13):1017-25. PMID 7563451

National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333(24):1581-7. PMID 7477192

Rai AT, Boo S, Buseman C, et al. Intravenous thrombolysis before endovascular therapy for large vessel strokes can lead to significantly higher hospital costs without improving outcomes. J Neurointerv Surg 2018;10(1):17-21. PMID 28062805

Saver JL, Gornbein J, Grotta J, et al. Number needed to treat to benefit and to harm for intravenous tissue plasminogen activator therapy in the 3- to 4.5-hour window: joint outcome table analysis of the ECASS 3 trial. Stroke 2009;40(7):2433-7. PMID 19498197

We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode’s original release date.