edward p. sloan, md, mph ferne/emra session: treating ischemic stroke patients using a 3 to 4.5 hour...
TRANSCRIPT
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Edward P. Sloan, MD, MPH
FERNE/EMRA Session: FERNE/EMRA Session:
Treating Ischemic Stroke Treating Ischemic Stroke Patients Using a Patients Using a
3 to 4.5 Hour tPA Window3 to 4.5 Hour tPA Window
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Edward P. Sloan, MD, MPH
2009 ACEP Scientific Assembly & EMRA Semi-Annual Meetings
Boston, MABoston, MA
October 6, 2009October 6, 2009
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Edward P. Sloan, MD, MPH, FACEP
Edward P. Sloan, MD, MPH
Professor
Department of Emergency MedicineUniversity of Illinois at Chicago
Chicago, Illinois
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Edward P. Sloan, MD, MPH, FACEP
Attending PhysicianEmergency Medicine
University of Illinois HospitalSwedish American Belvidere Hospital
Chicago, IL
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Edward P. Sloan, MD, MPH, FACEP
DisclosuresDisclosuresFERNE Chairman and PresidentFERNE Chairman and PresidentFERNE grants by industryFERNE grants by industryParticipation on industry-sponsored advisory Participation on industry-sponsored advisory
boards and as lecturer in programs boards and as lecturer in programs supported by industrysupported by industry
ACEP Clinical Policy CommitteeACEP Clinical Policy Committee2009 EMRA at ACEP Educational activities 2009 EMRA at ACEP Educational activities
supported by unrestricted Educational Grants supported by unrestricted Educational Grants from Genentech, EKR Therapeutics, Inc., and from Genentech, EKR Therapeutics, Inc., and The Medicines CompanyThe Medicines Company
No specific disclosures related to this topic.No specific disclosures related to this topic.
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Edward P. Sloan, MD, MPH, FACEP
www.ferne.orgwww.ferne.org
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Edward P. Sloan, MD, MPH, FACEP
Personal ExperiencePersonal Experience• 10 years, ~20 lectures Re: tPA use10 years, ~20 lectures Re: tPA use• Preparing clinicians for optimal care of Preparing clinicians for optimal care of
ischemic stroke patientsischemic stroke patients• Explaining the standard of care as seen by Explaining the standard of care as seen by
patients and societypatients and society• Participation in medico-legal casesParticipation in medico-legal cases• Awareness of both perspectivesAwareness of both perspectives
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Edward P. Sloan, MD, MPH, FACEP
The Initial tPA Data
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
Responses by Our Medical Societies
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
tPA 3-4.5 Hour Data
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
Recent Responses
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
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Edward P. Sloan, MD, MPH, FACEP
tPA Use FactstPA Use Facts• tPA has been shown to be effectivetPA has been shown to be effective• tPA can be used clinically with success in the care of tPA can be used clinically with success in the care of
stroke patientsstroke patients• Patients and society expect tPA usePatients and society expect tPA use• Clinicians remain divided Re: tPA useClinicians remain divided Re: tPA use• The ASA has now forced our handsThe ASA has now forced our hands• We must lead efforts Re: use of tPA in the 3-4.5 hour We must lead efforts Re: use of tPA in the 3-4.5 hour
windowwindow
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Edward P. Sloan, MD, MPH, FACEP
This Educational SessionThis Educational Session• This introduction and perspectiveThis introduction and perspective• E Bradshaw Bunney, MD: The 3-4.5 E Bradshaw Bunney, MD: The 3-4.5
hour window tPA datahour window tPA data• Panel discussion:Panel discussion:
• What do we think?What do we think?• What should we do in our systems?What should we do in our systems?• What are the best clinical options?What are the best clinical options?
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Edward P. Sloan, MD, MPH, FACEP
Panel DiscussionPanel Discussion• Yu-Feng Yvonne Chan, MDYu-Feng Yvonne Chan, MD
• Mt Sinai, NY, NYMt Sinai, NY, NY• SAEM Neuro Interest GroupSAEM Neuro Interest Group
• E Bradshaw Bunney, MDE Bradshaw Bunney, MD• Univ Illinois, Chicago, ILUniv Illinois, Chicago, IL• FERNEFERNE• Residency DirectorResidency Director• Get with the GuidelinesGet with the Guidelines
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Edward P. Sloan, MD, MPH, FACEP
Panel DiscussionPanel Discussion• Jonathan Edlow, MDJonathan Edlow, MD
• Beth Israel Hospital, Boston, MABeth Israel Hospital, Boston, MA• FERNE FERNE • Neurological EmergenciesNeurological Emergencies
• Richard Shih, MDRichard Shih, MD• Morristown Memorial Hospital, NJMorristown Memorial Hospital, NJ• Residency DirectorResidency Director• MEMC V Scientific ChairMEMC V Scientific Chair
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Edward P. Sloan, MD, MPH, FACEP
Clinical QuestionsClinical Questions• Is the 3-4.5 hour window data Is the 3-4.5 hour window data
adequately supportive of the ASA adequately supportive of the ASA recommendation Re: tPA use?recommendation Re: tPA use?
• Will it be possible for clinicians to Will it be possible for clinicians to replicate the ECASS 3 outcomes?replicate the ECASS 3 outcomes?
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Edward P. Sloan, MD, MPH, FACEP
Systems QuestionsSystems Questions• What must be done in our institutions What must be done in our institutions
in order to implement the ASA in order to implement the ASA recommendations?recommendations?
• What are some unique approaches to What are some unique approaches to the use of tPA in the 3 -4.5 hour the use of tPA in the 3 -4.5 hour window?window?
• How should we continue to educate How should we continue to educate in order to optimize stroke patient in order to optimize stroke patient care and EM clinical practice?care and EM clinical practice?
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Edward P. Sloan, MD, MPH, FACEP
Unanswered QuestionsUnanswered Questions• Up to 3 hours: tPA first, then Up to 3 hours: tPA first, then
interventional radiology techniquesinterventional radiology techniques• In the 3 -4.5 hour window, what is the In the 3 -4.5 hour window, what is the
best approach?best approach?
• Has anything changed significantly?Has anything changed significantly?• Where do we go from here?Where do we go from here?
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Edward P. Sloan, MD, MPH, FACEP
ConclusionsConclusions• Important disease stateImportant disease state• Patients and clinicians care about the Patients and clinicians care about the
use of tPA in optimizing outcomesuse of tPA in optimizing outcomes• This is an evolving processThis is an evolving process• FERNE continues to educate FERNE continues to educate • Clinicians continue to clarify practiceClinicians continue to clarify practice• Systems continue to adapt to needsSystems continue to adapt to needs
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Edward P. Sloan, MD, MPH, FACEP
Questions?Questions?
www.FERNE.org
ferne_emra_acep_2009_sloan_stroke_intro_100609_final04/21/23 18:21