Clot-busters for acute stroke is one of the more controversial interventions. Normally, the recommendation is for a 3-hour window between drug and onset of symptoms.
A recent study suggests that this can be lengthened to 4 1/2 hours.
There is no mortality benefit to using thrombolytics.
The downside is the not insignificant risk of bleeding leading to neurological complications, which malpractice attorneys are taking advantage of. It was 2.4 percent in the reported study.
It is because of the risk of being sued that emergency physicians are gun-shy about using the drug.
One answer? WhiteCoat suggests immunity:
If an emergency physician gets a CT report from a radiologist that says “no bleed,” the patient meets the criteria for thrombolytic therapy and doesn’t have any exclusion criteria, then the emergency personnel cannot be held liable for any bad outcomes for giving thrombolytics.
That’s an extreme measure, and unlikely to happen. However, if the public demands increased clot-busting use in stroke, that’s what it may take to convince some doctors to use them.
It’s better to emphasize to patients about the very real risks of thrombolytics for only potentially marginal benefits that do not impact mortality.
Let the patients decide.
