Tissue Plasminogen Activator and Patients with Acute Ischemic Stroke: The Litigation Landscape

Division

North Florida

Hospital

Osceola Regional Medical Center

Document Type

Review Article

Publication Date

1-22-2022

Keywords

tissue plasminogen activator, tPA, stroke

Disciplines

Cardiovascular Diseases | Emergency Medicine | Nervous System Diseases

Abstract

Objective

Tissue plasminogen activator (tPA) is considered standard of care for acute ischemic stroke treatment, but some physicians withhold or delay this highly time-dependent therapy from stroke patients because they do not think it works well or they are worried about the adverse effects or fear medico-legal consequences. The authors sought to investigate whether litigation arises from physicians treating versus not treating acute ischemic stroke patients with tPA.

Methods

The authors examined closed cases from 1996 to 2020 in an online legal database, Westlaw, regarding alleged complaints for whether or not thrombolytic treatment was given for acute stroke.

Results

Sixty-six relevant cases were identified. In all 66 cases, the plaintiffs sued for issues stemming from either failure to give tPA or a delay in giving tPA. In 77% of cases the verdict was in favor of the defendant. Only 1 lawsuit included intracerebral hemorrhage after tPA, but it was brought forth owing to delay in giving tPA; the verdict was in favor of the defendant.

Conclusion

It is more common for patients to sue physicians for not administering tPA in a timely fashion or at any point. Medicolegal risks of withholding or delaying tPA are clear, whereas we found no clear medicolegal risk to providing tPA when indicated.

Publisher or Conference

Journal of the American College of Emergency Physicians Open

Link to Full Text

Share

COinS