Timely administration of “tPA” in managing Acute ischemic stroke
II. Support your paper with at least two references and a research article. Your research article should meet the following requirements.
Supports the topic of the paper “Timely administration of “tPA” in managing Acute ischemic stroke”
No more than 5 years old
Qualitative or quantitative
Research study (population, sample size, results, conclusion etc.)
III. Your paper must contain detailing on how the research article you chose and presented supports the topic “Timely administration of TPA in managing Acute ischemic stroke”
IV. Analyze the outcomes to evaluate the effectiveness of the diagnosis and treatment plan
V. Identify how the treatment plan could have been altered in a way that either increased the effectiveness of the treatment, increased the safety of the treatment, and/or decreased the cost of the treatment without decreasing the treatment’s/healthcare service’s effectiveness.
Currently, stroke is categorized as a global health issue that is preventable and also treatable. Every year more than 795 000 people suffer from stroke in the US. Stroke is also a costly illness with a heavy financial burden not only to the patients and their families but also to the economy through loss in productivity and finances utilized by governments in stroke treatment programs (McVerry et al., 2019). In the U.S. stroke is the fifth leading cause of death and is also one of the leading causes of physical disability-adjusted life years globally. Over the years the concept of ‘time is brain’ has been integrated into stroke management across healthcare facilities. This concept highlights the importance of every second in stroke management especially in the emergency unit because if time is wasted more brain tissue is lost during a stroke (McVerry et al., 2019). It is therefore important for healthcare practitioners to act quickly when a stroke strikes with patients requiring urgent medical attention. Over the years evidence-based treatment has been developed for stroke patients known as thrombolysis treatment. Thrombolysis treatment helps save the brain cells from irreversible damage by breaking up clots that form in the brain after a stroke (Dhaliwal et al., 2019). Thrombolysis treatment is an effective treatment for acute ischemic stroke (AIS) but needs to be administered within 4.5 hours after the onset of symptoms to be effective. Thrombolytic therapy that relies on a tissue plasminogen activator (tPA) is the only licensed treatment for AIS. Over the years different randomized controlled trials have indicated that intravenous tissue plasminogen activator (tPA) significantly improves three months functional outcomes of patients after an acute ischemic stroke when compared to no reperfusion therapy(Dhaliwal et al., 2019). tPA has also been shown to significantly improve the outcomes of acute ischemic stroke patients within one year and one and a half years compared to other treatment approaches such as no reperfusion therapy. Scholarly studies have also indicated that earlier administration of tPA will be associated with a lower risk of mortality in healthcare facilities, better functional outcomes during discharge and after three months, and lower risk of hemorrhagic transformation compared to lower administration of tPA (Dhaliwal et al., 2019).
Man et al., (2020) quantitative research study supports the topic of the timely administration of “tPA” in managing AIS in that it seeks to determine the association between tPA door-to-needle time administration and one-year readmission and mortality among patients with acute ischemic stroke. Man et al., (2020) study was conducted in order to determine whether earlier administration of tPA among patients with AIS would translate into improved long-term outcomes among such patients. Man et al., (2020) relied on the retrospective cohort approach targeting elderly people above 65 years old who were Medicare beneficiaries and who had received intravenous tPA treatment within 4.5 hours from the time the onset of their symptoms had been noticed. Man et al., (2020) targeted numerous health care facilities for a period between January 1st, 2006, and December 31st, 2016. The study also involved a follow-up. The main variable that was considered in Man et al., 2020) therefore included door-to-needle times for intravenous tPA. Man et al., (2020) study involved 61426 patients with all the patients receiving tPA for AIS within 4.5 hours. The median age for the research participants was 80 years with at least 43.5% of the participants being male and the rest female. According to Man et al., (2020) among all elderly patients treated with TPA the patients who had a longer door-to-needle time of more than 45 minutes experienced a significantly higher readmission rates for different causes and mortality rates for different causes compared to those who had a shorter needle time. On the other hand, patients who had a door to needle time of more than 60 minutes had a higher adjusted hazard ratio and higher mortality rates from different causes, and also higher readmission rates from all causes compared to patients that were treated in less than 60 minutes. Man et al., (2020) study therefore clearly highlights that a longer door-to-needle time among elderly patients with AIS who are treated with tPA will be associated with higher mortality from different cause, higher rates of readmission, and a higher hazard ratio. On the other hand among elderly patients with AIS who are treated with tPA short door to needle times will be associated with lower readmission rates from different causes and 1-year lower mortality rates from all causes and a lower hazard ratio.
Effective diagnosis and timely beginning of tissue plasminogen activator (tPA) treatment are therefore essential for patients with AIS. A shorter door to needle time is associated with improved outcomes among patients receiving tPA treatment including lower readmission from all causes at 1-year, lower mortality rates from all causes, and a lower hazard ratio.
The reduction of the door to needle time during tissue plasminogen activator (tPA) treatment among elderly patients with acute ischemic stroke significantly increases the effectiveness of the treatment and decreases the cost of the treatment because acute ischemic stroke patients will enjoy better outcomes with a reduction in the door to needle times.
Dhaliwal, J., Ferrigno, B., Abiola, O., Moskalik, A., Sposito, J., Wolansky, L. J., Mui, G., Bulsara, K. R., & Mittal, S. (2019). Hospital-based intervention to reduce tPA administration time. Interdisciplinary Neurosurgery, 15, 15–18. https://doi.org/10.1016/j.inat.2018.09.005
Man, S., Xian, Y., Holmes, D. N., Matsouaka, R. A., Saver, J. L., Smith, E. E., Bhatt, D. L., Schwamm, L. H., & Fonarow, G. C. (2020). Association Between Thrombolytic Door-to-Needle Time and 1-Year Mortality and Readmission in Patients With Acute Ischemic Stroke. JAMA, 323(21), 2170. https://doi.org/10.1001/jama.2020.5697
McVerry, F., Hunter, A., Dynan, K., Matthews, M., McCormick, M., Wiggam, I., Vahidassr, D., McErlean, F., Stevenson, M., Hopkins, E., McKee, J., Kelly, J., Kennedy, F., & McCarron, M. O. (2019). Country-Wide Analysis of Systemic Factors Associated With Acute Ischemic Stroke Door to Needle Time. Frontiers in Neurology, 10. https://doi.org/10.3389/fneur.2019.00676