Tissue plasminogen activator for transient ischemic attack: the case for “off-label” use of thrombolytics

• Published in: The American journal of emergency medicine Vol. 32; no. 3; pp. 277 - 279
• Main Authors: Sobel, Richard M., MD, MPH, Wu, Daniel T., MD, Hester, Kristina, MD, Anda, Kim, RN
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2014; Elsevier Limited
• Subjects: Adult; Blood clots; Decision Support Techniques; Emergency; Emergency medical care; Female; Fibrinolytic Agents - therapeutic use; Heart attacks; Hemorrhage; Hospitals; Humans; Ischemia; Ischemic Attack, Transient - diagnosis; Ischemic Attack, Transient - drug therapy; Mortality; Off-Label Use; Patients; Risk Assessment; Stroke; Studies; Tissue Plasminogen Activator - therapeutic use; Veins & arteries
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2013.10.046

According to some studies, 15% of patients presenting to the emergency department with transient ischemic attack symptoms will have CVA within 7 days, and 30% within 1 year of transient ischemic attack symptoms [7]. [...]selected patients are eligible for treatment utilizing the expanding window (4.5 hours). [...]previously thought unacceptable enhanced risks of intracerebral hemorrhage after TPA administration during the 3- to 4.5-hour period from symptom onset are now considered to be out-weighed by the likelihood of functional benefit in defined patient populations. [...]we believe there is opportunity for risk/benefit analysis in reasonable individual circumstances. [...]the question remains; can the physician judiciously weigh the projected risks and benefits of TPA administration for selected individual cases?