Thrombolysis for Acute Stroke: Much Talk, Little Action

Myriad studies have demonstrated the effectiveness and safety of tissue plasminogen activator (tPA) when administered under the appropriate circumstances and its deleterious effects when administered improperly or in small, nonacademic, nonstroke-center hospitals without specific policies and procedures for its use. These studies have given rise to two vocal camps of emergency physicians — one for and one against use of tPA — largely split according to the type of center in which the EP practices.

To identify hospital and patient characteristics associated with administration of tPA, researchers analyzed data from the Nationwide Inpatient Sample for 1999 through 2004. Of nearly 370,000 patients with acute ischemic stroke who were admitted th…