New guidelines published by the American Heart Association (AHA) urge administration of clot busting medications, called tissue plasminogen activator (or, TPA), within 60 minutes of arrival at a hospital. TPA dissolves clots. It can be given intravenously or applied directly to the clot through a catheter in a procedure performed by an interventional radiologist. TPA can only be given when the onset of the stroke is reasonably known and when it is caused by a clot. In cases of a brain bleed, tPA cannot be used.
The guidelines emphasize the importance of timely administration of tPA. The authors, publishing their guidelines in the AHA journal, state that “[t]he goal of these guidelines is to limit the morbidity and mortality associated with stroke.” One step in early treatment is early recognition. The guidelines promote public education using the F.A.S.T. (face, arm, speech, time) campaign, first introduced 10 years ago. FAST is premised on that fact that facial drooping, arm weakness and/or slurred speech are present in 88% of all strokes and TIAs. Time is of the essence in evaluating and treating such patients.
Other important components are:
- Patients should be quickly taken to the nearest stroke center for treatment.
- If no such center is nearby, the patient should be taken to the most appropriate institution that provides emergency stroke care. In hospitals that do not offer such expertise, the AHA recommends telephone consultations with specialists in other institutions.
- The sooner clot busters can be given, the better, in order to minimize the amount of brain injured and other complications of delayed treatment.
Under Ohio law, a medical malpractice case may arise when physicians fail to provide care in accordance with these guidelines. We have handled cases involving delays in diagnosis when caregivers fail to recognize obvious signs of ischemia caused by a thromboembolism, cases involving the failure to institute proper treatment (either tPA or anticoagulation, depending on the circumstances), and cases involving failure to take proper preventative measures, such as negligent failure to therapeutically anticoagulate a patient who has atrial fibrillation (A Fib) or negligent failure to perform endarterectomy in a patient with an occluded carotid artery.