my side of a pro con debate on tpa for stroke at IAEM 2014

1. a confession

2. is there
doubt here?

3. Brown SGA, Macdonald SPJ, Hankey GJ. Do risks outweigh benefits in thrombolysis for stroke? BMJ. 2013 Aug 29;347(aug29 1):f5215–5.

5. steroids for spinal cord injury
activated protein C for sepsis
percutaneous stroke intervention

6. never mind…
conflicts
http://www.stephenhicks.org/wp-content/uploads/2012/10/conflict-interest.png
misdiagnosis
http://renegadehealth.com/blog/wp-content/uploads/2012/11/misdiagnosis-small.jpg
http://lowres.cartoonstock.com/fashion-fashions-pants-belts-high_waisted-fashion_
statement-mbcn3273_low.jpg
eligibility

7. individual studies
systematic reviews
guidelines

8. guidelines

9. http://www.acepnow.com/article/acep-council-votes-reconsider-clinical-policy-use-intravenous-tpa-manage-acute-ischemic-stroke-ed/

10. Lenzer J. Why we can't trust clinical guidelines. BMJ. 2013 Jun 14;346(jun14 2):f3830–0.

11. Shinton R. Questions about authorisation of alteplase for ischaemic stroke. The Lancet. 2014 Aug 23;384(9944):659–60.

12. systematic
reviews

13. Thompson SG. Why sources of heterogeneity in meta-analysis should be investigated. BMJ. 1994 Nov 19;309(6965):1351–5.

14. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated
systematic review and meta-analysis. Lancet. 2012 Jun 23;379(9834):2364–72.

16. individual
studies

17. http://www.ncbi.nlm.nih.gov/pubmed/18815396
NINDS
http://www.ncbi.nlm.nih.gov/pubmed/7477192
http://www.ncbi.nlm.nih.gov/pubmed/12016245
ECASS III

18. guidelines
systematic reviews
individual studies

19. image credit: http://thesgem.com/2014/09/sgem85-wont-get-fooled-again-tpa-for-cva/