Saturday, December 15, 2018

The campaign against reperfusion therapy for stroke

It’s the most massive push-back I’ve ever seen in my career. It’s profiled in this NYT article. This isn’t new, and I’m surprised the popular media hasn’t caught hold of it before now. The opinion leader is Dr. Jerome Hoffman, professor of emergency medicine at UCLA. The article has drawn over 200 comments so far. I thought this one was interesting from an ER doc:

As an ER Doc, I am disheartened by the continued resistance by some in my specialty who to chose to deny this treatment option for appropriate patients. There are risks and benefits to every medical intervention but in this case many of us overstate the former and underestimate the latter.

I have personally debated with Dr. Hoffman (yes, he is charismatic but no, he most certainly did not win over that audience) and despite his assertions about case selection in the original trial, additional trials over the ensuring 22 years since FDA approval have repeatedly confirmed tPA as the international standard of care for acute ischemic stroke.

The concerns about the 11 "negative trials" are ludicrous. Much was unknown at the time these were conducted: they looked at higher doses, different drugs, and longer time eligibility windows that, if used today, would be malpractice. Yet these 11 studies were critical in defining today's standard of care. Therefore it is extremely disingenuous to cite them as evidence to justify denying our patients this critical intervention today.

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