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Administration of tissue plasminogen activator (tPA) in the first few hours after an ischemic stroke has become widespread, but the risks and benefits of this intervention remain controversial. These authors sought to determine how often tPA is wrongly given to patients with presumed stroke who are ultimately diagnosed with a non-stroke cause of their presenting symptoms and to assess these patients' outcomes. The authors reviewed the charts of all patients who were treated with tPA for presumed ischemic stroke at 4 emergency departments in Michigan.
Before administering tPA, emergency physicians had the option of consulting with a neurologist; consultations were obtained for 97 of 151 patients (58 bedside and 39 telephone consultations). Si…