Newer Intervention in Care of Neuro Patients
I actually wrote my EBP on the stroke alert policy and I found so many good articles about the management of stroke. One of the articles was quite interesting since it talked about a drug that is under research right now. According to that article, tPA has the ability to modulate blood vessel tone and to increase blood-brain barrier permeability (Freeman, 2014). The non-fibrinolytic action on the blood-brain barrier may be related to the ability of tPA to induce intra-cranial hemorrhage and cerebral edema (Freeman, 2014). The tPA is the only approved thrombolytic agent for patient with ischemic stroke. It has many limitations and inclusion criteria, like strict time constraints of 3 to 4.5 hours since the onset of symptoms, low risk of bleeding, have a measurable persistent neurological deficit, negative non-contrast head CT scan, serum glucose between 50–400 mg/dL, platelet count above 100,000/mcL, and INR less than 1.7, etc. (Berry et al., 2015).
The new drug, desmoteplase, is not approved by FDA yet, but is under clinical development now. It is considered to be a safer option compared to tPA, since it does not induce plasmin-dependent opening of a blood-brain barrier and has less risk of inducing intra-cerebral hemorrhage (Freeman et al., 2014).
Another article that I actually have not used for my paper talks about the economical impact of tPA. According to its authors, the use of tPA accounts for a cost-saving of $3454 per treated patient over a six-year period (Kazley, 2013). This study was done in South Carolina. The article estimates that increasing the current use of tPA from 3% to 20% over the five years will potentially increase the cost-savings to $16,615,723 (Kazley, 2013). Calculating the cost-saving costs, the researchers included daily rehabilitation cost, daily home health cost, etc., of patients treated with tPA and those who were not treated. I liked the idea of increasing the tPA to 20% and improved economic impact. However, tPA has so many exclusion and inclusion criteria, and thus many limitations. So this goal might be very hard to achieve with tPA. Desmoteplase, on the other hand is so much safer and has fewer limitations, so it could be used in many more cases to improve patients outcomes and achieve their higher cost-saving economical impact.
References
Berry, K., Al-Zubidi, N., & Seifi, A. (2015). Should serum sodium level be part of stroke protocol prior to tPA administration? Journal of the Neurological Sciences, 357(1), 317-318. http://dx.doi.org/10.1016/j.jns.2015.07.035
Freeman, R., Niego, B., Croucher, D., Pedersen, L., & Medcalf, R. (2014). tPA, but not desmoteplase, induces plasmin-dependent opening of a blood-brain barrier model under normoxic and ischemic conditions. Brain Research, 1565 (1), 63-73. doi: 10.1016/j.brainres.2014.03.027
Kazley, A., Simpson, K., Simpson, A., Jaunch, E., & Adams, R. (2013). Optimizing the economic impact of rtPA use in a stroke belt state: The case of South Carolina. American Health & Drug Benefits, 6(4), 155-162.
