Views of Emergency Physicians on Thrombolysis for Acute Ischemic Stroke

BACKGROUND The 3-hour window for treating stroke with intravenous tissue plasminogen activator (t-PA) requires well-organized, integrated efforts by emergency physicians and stroke neurologists. OBJECTIVE To evaluate attitudes and knowledge of emergency physicians about intravenous t-PA for acute ischemic stroke, particularly in primary stroke centers (PSCs) with stroke neurology teams. METHODS A 15-question pilot Internet survey administered by the Arizona College of Emergency Physicians. RESULTS Between March and August 2005, 100 emergency physicians responded: 71 in Arizona and 29 in Missouri. Forty-eight percent practiced at PSCs; 48% thought t-PA was effective, 20% did not, and 32% were uncertain. PSC or non-PSC location of practice did not influence endorsement (odds ratio, 0.96; 95% confidence interval, 0.27-1.64). Of those opposing t-PA, 87% cited risk of hemorrhage. CONCLUSIONS Most emergency physicians did not endorse t-PA. Improved collaboration between emergency physicians and stroke neurologists is needed.