Podcast #412: tPa Mission Creep - The Emergency Medical Minute

Author: Aaron Lessen, MD

Educational Pearls:

  • Patients with “minor” strokes with NIHSS 0 to 5  can still end up having poor long-term outcomes
  • Recent study compared use of alteplase vs. aspirin for these patients and saw no difference in regards to favorable neurologic outcome at 90 days
  • Study was ended early due to patient recruitment difficulties

Editor’s note: though ended early, it is debatable whether even if appropriately powered there would have been an identifiable benefit



Khatri P, Kleindorfer DO, Devlin T, Sawyer RN Jr, Starr M, Mejilla J, Broderick J, Chatterjee A, Jauch EC, Levine SR, Romano JG, Saver JL, Vagal A, Purdon B, Devenport J, Pavlov A, Yeatts SD; PRISMS Investigators. Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial. JAMA. 2018 Jul 10;320(2):156-166. doi: 10.1001/jama.2018.8496. PubMed PMID: 29998337.

Summary by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD


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