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  • Title: Tissue plasminogen activator (tPA) in acute ischaemic stroke: time for collegiate communication and consensus.
    Author: Levi CR, Australasian Stroke Unit Network, New South Wales Greater Metropolitan Transition Taskforce Stroke Initiative, Towards A Safer Culture Stroke Expert Working Group.
    Journal: Med J Aust; 2004 Jun 21; 180(12):634-6. PubMed ID: 15200362.
    Abstract:
    Systematic reviews of randomised trials of tPA in acute ischaemic stroke indicate a clear benefit of treating selected patients within 3 hours of stroke onset. Moreover, a net benefit remained after adjustment for chance baseline imbalances between subgroups in stroke severity within one of these trials (National Institute of Neurological Disorders and Stroke [NINDS]). Rates of favourable outcomes and intracranial haemorrhage comparable with those in randomised trials can be achieved in routine clinical practice; however, translation of net benefit from tPA therapy requires organised and coordinated stroke management across the continuum of care. Prerequisites for well organised and coordinated acute stroke care are: consensus among care providers on the use of tPA; stroke-care teams spanning the gaps between pre-hospital care, emergency departments and stroke units; and collegiate relations and effective communication networks between care providers.
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