November 25, 2021
Tissue Plasminogen Activator (tPA) is a potential lifesaving medication which can be administered to certain stroke patients. In order to be effective, tPA must be administered with a short window of time after the onset of stroke symptoms. This alone, creates a logistic challenge for its use. This challenge is multiplied by the fact that each use of tPA for stroke must be approved by a neurologist. What if there is no neurologist available? This is particularly relevant in smaller hospitals, especially in remote areas? An increasingly popular solution to this problem is the adoption and implementation of technologically advanced tele-stroke remote ICU services.
Stroke is a leading cause of disability and death globally and in the U.S., where around 800,000 people experience a stroke every year.
tPA is a clot-dissolving medicine which made waves in the medical industry in 1996 as the first acute ischemic stroke treatment to receive approval from U.S. Food and Drug Administration (FDA).
tPA, now the gold-standard treatment for ischemic stroke, is an emergency medication which breaks up blood clots which may be blocking blood flow to brain regions affected by a stroke. tPA is delivered intravenously or by an intra-arterial injection directly to the site of the blockage in the brain. The latter technique is especially favorable for patients who have recently undergone surgery, are on blood thinners, or might have missed the critical three-hour administration window (as determined by the FDA) since tPA itself “thins” the blood and can cause significant and even catastrophic bleeding.
In 2018, The American Heart Association strongly advised using tPA even beyond 3 but within 4.5 hours after the onset of stroke symptoms. Nevertheless, the earlier the administration of the clot-dissolving medicine, the better the overall outcome regarding complications, brain damage, functional impairment, and survival.
Given the aforementioned risks of tPA administration, providers, including a neurologist, must first determine patient eligibility and rule out other stroke types since tPA only appropriate for and effective in acute ischemic or thrombotic strokes, not hemorrhagic strokes or head trauma, as it may cause excessive bleeding. Additionally, before tPA approval and administration, patients undergo a series of tests and evaluations to assess the potential risks (and benefits) in their specific case. The challenges don’t end with the ultimate administration of tPA. Post-administration monitoring is key to improving outcomes. If complications occur, the FDA-approved drug aminocaproic acid can reverse tPA’s effects on the blood and, hopefully, stop any bleeding which may have occurred.
As one can see from the above, appropriate management of strokes requires immediate intervention by a neurological specialist with experience in making fast decisions under pressure. However, what if there is no available neurologist, as is often the case, especially at small outlying hospitals (which may have no neurologist at all)?
AS a solution to this problem, an increasing number of hospitals are availing themselves of remote technology solutions developed and offered by telemedicine companies, such as RemoteICU. These companies can provide off-site physicians 24/7. including remote telemedicine neurology. In case of time-critical strokes, hospitals linked to telemedicine services have immediate access to a consulting remote neurologist, who can issue the mandated approval for administration of tPA for incidents of stroke.
In short, tPA is a powerful medication which requires immediate availability of a neurology specialist for its approval and administration. Telemedicine neurology can bring this potentially lifesaving treatment to even the smallest and most remote hospitals.
We provide hospitals with Tele-ICU shifts, for existing and new Virtual ICUsLearn more
Our Internal Medicine telehospitalists cover the smallest to the largest hospitalsLearn more
Our teleneurologists perform general neurology, in addition to tPA administration for stroke via TeleStrokeLearn more
Our telemedicine coverage is replicated and performed for all inpatient or outpatient specialtiesLearn more