ArticleJournal of the American College of Emergency Physicians open2022
Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape.
Article in Journal of the American College of Emergency Physicians open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
4 citing papers in PubMed, 7 citations in OpenAlex.
- Optimizing Stroke Pathways: An Observational Audit of Door-to-CT Time, Thrombolysis, and Clinical Outcomes.Cureus · 2025Article
- Management of acute ischemic stroke in the emergency department: optimizing the brain.International journal of emergency medicine · 2025Review
- Opinion: can we bust the fear of symptomatic intracerebral hemorrhage due to tPA?Frontiers in neurology · 2024Article
- Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape.Journal of the American College of Emergency Physicians open · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTissue 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.
methodsThe 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.
resultsSixty-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.
conclusionIt 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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.