Interim Response to ACEM review of tPA
Today the Australian College of Emergency Medicine released a review of Intravenous t‑PA, which raised concerns around the increased risk of haemorrhage associated with the treatment.
t-PA, or thrombolysis, is currently recommended as a leading treatment for ischaemic stroke in Australia and around the world.
The evidence that tPA reduces disability is unequivocal and also demonstrated in the ACEM review. We know this powerful treatment is proven to increase rates of recovery and independence in patients who suffer an ischaemic stroke.
Patients who have had an ischaemic stroke, caused by a blood clot, have a small window of time to receive tPA, to potentially reduce permanent brain damage and disability. For these patients, early admission to a stroke unit with thrombolysis is one of the biggest factors affecting their chances of a good recovery.
The risk of bleeding complications does need to be considered and patients must be carefully selected by clinicians to minimise this risk. However, it is important that this risk is balanced against the high risk of severe disability associated with untreated stroke.
It is crucial that t-PA is administered in stroke units, and emergency departments with appropriate expertise and infrastructure for monitoring, rapid assessment and investigation of patients with acute stroke.
Current, Stroke Foundation clinical guidelines recommend thrombolysis treatment of ischemic stroke patients within 4.5 hours of symptom onset. Stroke patients need to be prioritised by ambulance and hospital staff to ensure those who can benefit from thrombolysis have the opportunity to access it in time. A review of the stroke clinical guidelines, including the use of tPA, is currently underway.
Currently only 26 percent of ischemic stroke patients in Australia receive disability reducing thrombolysis treatment within 60minutes of hospital arrival, compared with 43 percent of American patients and 56 percent of stroke patients in the UK.
It is crucial that Australian health professionals are informed about the latest evidence-based treatments for stroke and supported to deliver them safely. Our stroke patients deserve to have the best possible chance of making a good recovery after stroke.