Delayed Stroke Diagnosis, tPA Not Administered

This case involves the care of a patient who had stroke-like symptoms which were recognized by nursing staff members. However, the internist on call was unavailable to see the patient and the delay in treatment lasted more than 3 hours. The symptoms were first recognized as “stroke like” within 1 hour of presentation and this patient would have otherwise been a candidate for tPA. Since the patient wasn’t seen by the internist until after the 3 hour window, the patient was no longer a candidate for TPA. The patient suffered from a massive stroke and died 2 months later of resulting complications.

Question(s) For Expert Witness

Please discuss your knowledge of the efficacy of the clot busting drug tPA and how statistical studies display proven benefits.

Expert Witness Response E-000684

I am a board certified vascular neurologist and have a Masters degree in Epidemiology. To be most effective in ischemic stroke, tPA must be administered as early as possible after the onset of symptoms. Protocol guidelines require its use intravenously within the first three hours of the event, after which its detriments may outweigh its benefits. I am a firm believer in the use of IV-tPA and have administered IV-tPA several hundred times. I have lectured extensively on stroke therapy and treatment.