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04-08-2011 | Stroke | Article

Neurologists’ comfort with tPA treatment increasing


Free abstract

MedWire News: US neurology residents have become increasingly comfortable with the use of tissue plasminogen activator (tPA) in patients with stroke, shows an analysis of data from the past decade.

A previous survey of neurology residents who were in their final year in 2000 found that 73% of 287 respondents felt comfortable using tPA in stroke patients.

The follow-up survey, of 491 final-year neurology residents in 2010, reveals that 94% of 286 respondents feel comfortable with providing tPA treatment.

"This is good news," said lead researcher Brett Cucchiara (University of Pennsylvania, Philadelphia, USA). "It is imperative that neurology residents attain a level of comfort using tPA that will allow them to use the medication effectively in their clinical practice and guide other physicians in its use."

However, as reported in the journal Stroke, only 65% of residents strongly agreed that they felt comfortable providing tPA treatment.

"Not surprisingly, a strong association exists between residents' personal experience with using tPA and their level of comfort in using tPA independently," said Cucchiara.

Residents who had personal experience of treating a stroke patient with tPA were 8.4-fold more likely to strongly agree that they were comfortable with tPA use, relative to those without such experience.

Also, having treated a patient without direct faculty supervision increased the likelihood of strong agreement 3.2-fold, the presence of a stroke team increased it 3.7-fold, and having formal training in the National Institutes of Health Stroke Scale (NIHSS) increased the likelihood of strong agreement 2.4-fold.

All these factors were more prevalent in survey responses from 2010 than from 2000. The proportion of residents who had observed tPA treatment rose from 88% to 99% between 2000 and 2010, the proportion who had personally used tPA rose from 80% to 95%, and the proportion who had used it both with and without supervision rose from 36% to 55%.

In 2000, 65% of residents had received formal NIHSS training, compared with 93% in 2010, and 84% and 93%, respectively, reported the presence of a stroke team.

"The increase in residents' familiarity, experience, and comfort reflects a larger trend in stroke treatment, as tPA is increasingly recognized as a critical part of stroke care," said Cucchiara.

But he added: "There are still some hospitals not yet geared up for treatment."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Eleanor McDermid