The use of lytics in stroke is perhaps the most controversial therapy in emergency medicine; too many EPs have evaluated the data, starting with the NINDS trial in 1995, to recent trials like IST-3, and decided that tPA is not worth the risk.
ACEP Clinical Policies are some of the most rigorously researched, evidence-based practice guidelines available – in any specialty. Over the years these guidelines have served to help answer questions and settle debates with other specialties – to translate research into practice and standardize emergency medicine.
So many of us were surprised when an ACEP Clinical Policy gave a Level A recommendation to offering tPA to patients that meet NINDS criteria within 3 hours. The guideline seemed to enshrine a therapy that was still very much under debate – and we're proud to say, much of that debate unfolded in these pages over the years.
So, under pressure from its EPs like us, the ACEP council and board has taken an unusual step: it's opened up the already-published policy for debate. Members can submit comments over the next 60 days to this website – and the board has promised to weigh the comments, and supplementary evidence provided. It's unclear if the tPA policy will be amended, or rescinded, but for the first time, we have a clear indication that our independent, evidence-based voice will be heard.
Comment on ACEP's tPA Policy