Is the Failure to Treat a Stroke with tPA Considered Medical Malpractice?


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Every year, more than 795,000 Americans have a stroke. A drug called tPA can improve outcomes for stroke patients, but it’s not given to everyone. When a doctor fails to provide prompt treatment for a patient, it can be difficult for a layperson to determine whether treatment was withheld for a valid medical reason or if their loved one was a victim of medical malpractice. To understand whether malpractice has occurred, you must first determine the underlying cause of the stroke and the medical history of the patient.

What Is tPA, And When Is It Given?

TPA (tissue plasminogen activator) is a protein that dissolves blood clots (the underlying cause of an ischemic stroke) and restores blood flow to the brain after a stroke. Because of this, it’s often referred to as a “clot-busting” drug. In the United States, tPA is often referred to by its generic name, alteplase.

The American Stroke Association recommends tPA treatment for almost all patients suffering from an ischemic stroke, the most common type. Unfortunately, tPA has the most benefit when used within 3 hours of stroke symptoms first appearing and can be dangerous to give more than 4.5 hours after a stroke. Because of this narrow treatment window, treatment is usually restricted to the minority of patients who recognize their symptoms early and get to the hospital right away.

Who Should Not Be Given tPA?

Because most strokes are ischemic, you might presume that most stroke victims should be given tPA as a matter of routine. Unfortunately, it’s not as simple as that. While it’s true that tPA is the only FDA-approved drug for treatment for ischemic stroke, there are some instances where it can be more harmful than helpful, even within the recommended treatment window.

Most of the contraindications to tPA revolve around the fact that tPA thins the blood, which can cause bleeding in some patients. If it happens in the brain, this bleeding can worsen stroke symptoms and potentially lead to death. Therefore, a healthcare provider needs to get an accurate medical history from the patient or their family members very soon after arriving at the hospital to determine whether a stroke patient is a candidate for tPA treatment. Some contraindications for tPA treatment include:

Current internal bleeding, such as:

  • hemorrhagic (bleeding) stroke
  • other active internal bleeding
  • recent head trauma

Likely to develop internal bleeding, such as:

  • neurosurgery, head trauma, or stroke in the past three months
  • severe, uncontrolled hypertension
  • prior history of bleeding in the brain
  • known aneurysm or neoplasm (tumor) in the brain
  • current use of anticoagulants (blood thinners)
  • low platelet count
  • very low blood sugar (<50 mg/dL)
  • major surgery or non-head trauma in the past two weeks

Due to the risk of bleeding and potential for neurotoxicity when used in the later stages of a stroke, it’s recommended to only give tPA within 3 to 4.5 hours of symptom onset, when the benefit outweighs the potential risks. It’s also typically not used in instances where a stroke is mild or where symptoms improve rapidly on their own. In these cases, the risk of bleeding would outweigh any potential benefit.

Is It Malpractice If tPA Is Not Given To A Stroke Patient?

While there’s an extensive list of reasons NOT to give tPA, about half of stroke victims who make it to the emergency room early and are properly diagnosed within the 3-to 4.5-hour window are candidates for tPA treatment. Unfortunately, there are instances where an eligible tPA candidate is not given tPA. In these cases, malpractice may play a role.

One instance of malpractice would be a misdiagnosis or delayed diagnosis. The current recommendation is a “door-to-needle” time of less than 1 hour. This means that a hospital if it’s following proper protocols, should accurately diagnose a stroke, get a medical history, and begin treatment with tPA (if indicated) within 60 minutes of a patient’s arrival. If protocols are not properly followed, or if a patient is misdiagnosed due to a provider’s negligence, then it’s possible that the tPA treatment window could be missed. In these instances, if it can be proven that a patient was tPA eligible and arrived at the hospital with enough time for a correct diagnosis to be made, then a doctor or healthcare facility might have committed medical malpractice.

I Believe My Loved One Was A Victim of Malpractice. What Can I Do?

If you think that your loved one was eligible for tPA treatment after a stroke but did not receive it due to a healthcare provider’s negligence, then your family may be entitled to compensation. The damage that a stroke does to the brain can be severe, and it can be challenging to move on, knowing that the damage could have been reduced or avoided if a doctor had provided appropriate treatment. In instances like these, it’s crucial to find an attorney experienced with stroke cases to fight for you and your family.

Why Choose Ross Feller Casey?

The legal team at Ross Feller Casey understands how difficult life can become after a stroke. We trust healthcare providers to follow recommended guidelines and provide safe and appropriate treatment. When doctors and hospitals break that trust, victims and their families should be compensated accordingly.

If you or someone you love has been the victim of medical malpractice, contact us today for a free consultation. With more than $1 billion recovered for our clients over the past five years alone, we know what it takes to get results in medical malpractice cases, including tPA lawsuits. There’s no fee unless you win, so don’t put it off any longer. We can help you get the justice that you and your family deserve.

Disclaimer: Ross Feller Casey, LLP provides legal advice only after an attorney-client relationship is formed. Our website is an introduction to the firm and does not create a relationship between our attorneys and clients. An attorney-client relationship is formed only after a written agreement is signed by the client and the firm. Because every case is unique, the description of awards and summary of cases successfully handled are not intended to imply or guarantee that same success in other cases. Ross Feller Casey, LLP represents catastrophically injured persons and their families in injury and wrongful death cases, providing legal representation in Pennsylvania and New Jersey.