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FERNE/EMRA Session: Treating Ischemic Stroke Patients Using a 3 to 4.5 Hour tPA Window

FERNE/EMRA Session: Treating Ischemic Stroke Patients Using a 3 to 4.5 Hour tPA Window. 2009 ACEP Scientific Assembly & EMRA Semi-Annual Meetings Boston, MA October 6, 2009. Edward P. Sloan, MD, MPH Professor Department of Emergency Medicine University of Illinois at Chicago Chicago, Illinois.

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FERNE/EMRA Session: Treating Ischemic Stroke Patients Using a 3 to 4.5 Hour tPA Window

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  1. FERNE/EMRA Session: Treating Ischemic Stroke Patients Using a 3 to 4.5 Hour tPA Window

  2. 2009 ACEP Scientific Assembly & EMRA Semi-Annual MeetingsBoston, MAOctober 6, 2009

  3. Edward P. Sloan, MD, MPHProfessorDepartment of Emergency MedicineUniversity of Illinois at ChicagoChicago, Illinois

  4. Attending PhysicianEmergency MedicineUniversity of Illinois HospitalSwedish American Belvidere HospitalChicago, IL

  5. Disclosures • FERNE Chairman and President • FERNE grants by industry • Participation on industry-sponsored advisory boards and as lecturer in programs supported by industry • ACEP Clinical Policy Committee • 2009 EMRA at ACEP Educational activities supported by unrestricted Educational Grants from Genentech, EKR Therapeutics, Inc., and The Medicines Company • No specific disclosures related to this topic.

  6. www.ferne.org

  7. Personal Experience • 10 years, ~20 lectures Re: tPA use • Preparing clinicians for optimal care of ischemic stroke patients • Explaining the standard of care as seen by patients and society • Participation in medico-legal cases • Awareness of both perspectives

  8. The Initial tPA Data

  9. Responses by Our Medical Societies

  10. tPA 3-4.5 Hour Data

  11. Recent Responses

  12. tPA Use Facts • tPA has been shown to be effective • tPA can be used clinically with success in the care of stroke patients • Patients and society expect tPA use • Clinicians remain divided Re: tPA use • The ASA has now forced our hands • We must lead efforts Re: use of tPA in the 3-4.5 hour window

  13. This Educational Session • This introduction and perspective • E Bradshaw Bunney, MD: The 3-4.5 hour window tPA data • Panel discussion: • What do we think? • What should we do in our systems? • What are the best clinical options?

  14. Panel Discussion • Yu-Feng Yvonne Chan, MD • Mt Sinai, NY, NY • SAEM Neuro Interest Group • E Bradshaw Bunney, MD • Univ Illinois, Chicago, IL • FERNE • Residency Director • Get with the Guidelines

  15. Panel Discussion • Jonathan Edlow, MD • Beth Israel Hospital, Boston, MA • FERNE • Neurological Emergencies • Richard Shih, MD • Morristown Memorial Hospital, NJ • Residency Director • MEMC V Scientific Chair

  16. Clinical Questions • Is the 3-4.5 hour window data adequately supportive of the ASA recommendation Re: tPA use? • Will it be possible for clinicians to replicate the ECASS 3 outcomes?

  17. Systems Questions • What must be done in our institutions in order to implement the ASA recommendations? • What are some unique approaches to the use of tPA in the 3 -4.5 hour window? • How should we continue to educate in order to optimize stroke patient care and EM clinical practice?

  18. Unanswered Questions • Up to 3 hours: tPA first, then interventional radiology techniques • In the 3 -4.5 hour window, what is the best approach? • Has anything changed significantly? • Where do we go from here?

  19. Conclusions • Important disease state • Patients and clinicians care about the use of tPA in optimizing outcomes • This is an evolving process • FERNE continues to educate • Clinicians continue to clarify practice • Systems continue to adapt to needs

  20. Questions? www.FERNE.org edsloan@uic.edu ferne_emra_acep_2009_sloan_stroke_intro_100609_final 10/1/2014 8:58 PM

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