A recent study in the Annals of Emergency Medicine found that out of a cohort of 33 malpractice litigation cases involving rTPA, 29 (88%) were initiated because of failure to treat with rTPA rather than for side effects of therapy.⁴¹ Given the potential for litigation, it is appropriate to have—and carefully document—an informed-consent-style discussion of risks and benefits with the patient/family when the patient is a candidate for treatment with rTPA.

Conclusion

AIS is a potentially devastating condition for which treatment is highly time-sensitive and infrequently administered. The emergency physician suspecting AIS should immediately rule out other causes of neurologic deficit, obtain prompt brain imaging, and consider the use of rTPA.

Given the complexity of issues surrounding the selection of appropriate candidates for thrombolysis and the conflicting data about its use in inexperienced centers, expert consultation should be considered mandatory in the care of AIS.

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Contributors

Dr. Aldeen is an assistant professor and the assistant residency director in the department of emergency medicine at Northwestern University Feinberg School of Medicine. Dr. Pirotte is a second-year resident in the department of emergency medicine at Northwestern University Feinberg School of Medicine. Medical Editor Dr. Robert C. Solomon is an attending emergency physician at Trinity Health System in Steubenville, Ohio, and clinical assistant professor of emergency medicine at the West Virginia School of Osteopathic Medicine.