Stroke treatment draws fire.

Editor:

The Directed Reading article in the May/June 2007 issue titled "Diagnosis and Treatment of Carotid Artery Disease" by Pamela J. Jones contained a segment on medical management of stroke derived from a Web site authored by Brian Silver, M.D. Dr. Silver recommended the use of tPA, a clot-dissolving drug manufactured by Genentec, Inc, as the only U.S. Food and Drug Administration-approved drug for the treatment of ischemic stroke. In his article, Dr. Silver quoted a 1995 study by the National Institute of Neurological Disorders and Stroke published in The New England Journal of Medicine suggesting that tPA would improve some patients' outcomes when administered within 90 minutes of the onset of symptoms.

As I finished the DR article and was in the process of completing the quiz, I noticed a letter to the editor in the June 12, 2007, edition of my local newspaper, The Wichita Eagle, by the medical director of Wesley Medical Center's Emergency Department in Wichita, Kansas. The author of this letter had an opinion on tPA treatment of strokes that differed considerably from that of Ms. Jones and her source, Dr. Silver.

In his letter to the Eagle, Dr. Mark Mosley wrote that "No study has ever shown that tPA for strokes can save your life, or even do anything beneficial while you are in the hospital." Dr. Mosley also stated in his letter that, "all of the national emergency physician groups in the United States and Canada have refused to endorse tPA for stroke as a 'standard of care' because of its 'lack of efficacy and safety.'" He concluded his letter by saying that the real story on strokes and stroke treatment hasn't been heard. As it turns out, according to Dr. Mosley, there are many medical professionals who should be better informed on this important topic.

Michael Phelan, B.S., R.T. (N), CNMT

Eureka, Kansas

The author responds:

Concerns about the original National Institute of Neurological Disorders and Stroke (NINDS) trial have been voiced before. As a result, in May 2002 an independent tPA Review Committee was established at the request of NINDS. The committee reaffirmed and reinforced the treatment benefit of the tissue plasminogen activator alteplase (Activase) when administered within 3 hours of stroke onset according to the NINDS tPA trial protocol. I invite readers to check the Web site Activase.com, where they will find clinical trials, studies of routine clinical use and data from the past few years to mitigate these concerns.

If I ever have stroke symptoms, I hope the physician in the emergency department I am taken to is informed enough to use tPA if warranted.

Pamela J. Jones, B.A., R.T. (R)(M), RDMS, RVT

West Mifflin, Pennsylvania