![]() But it’s still better to know what the individual patient would have wanted.īecause of that, he said the study emphasizes the importance of speaking with family, friends and doctors about treatment wishes before anything goes wrong, and writing those wishes down in advance directives. The survey results show that doctors can provide care that is consistent with most people’s wishes by giving tPA and related medications to eligible stroke patients, Chiong said. That might mean treating a patient with a severe stroke with tPA even when it seems risky to do so. He pointed out that stroke patients often see being left severely disabled and reliant upon their loved ones as worse than dying, and doctors should take that into consideration when making treatment decisions for patients who can’t make their own. “What we’re trying to do is to strike a balance because of the need for being very, very quick but also trying to do as much of an informed decision on the patient’s part as possible.” “I don’t think anybody is advocating for absence of discussion or presumption of consent,” Jauch, head of emergency medicine at the Medical University of South Carolina in Charleston, told Reuters Health. Jauch led the team that put together the American Heart Association/American Stroke Association guidelines that addressed consent issues for stroke patients. “It’s really about this dilemma that many physicians find themselves in of treating patients when we don’t know what their preferences are.”ĭr. “For us, this highlights the fact that these situations. So the researchers wanted to compare how potential patients saw both situations. ![]() It’s generally accepted that doctors and paramedics can ethically give CPR to a person whose heart has stopped and who cannot consent. A similar proportion said they would not want treatment. The other participants were asked if they would want to be given CPR after a sudden cardiac arrest. Twenty-four percent of participants asked about stroke said they would not want to receive tPA or similar medications if they arrived at the hospital after having a stroke, according to the findings published Tuesday in the Journal of the American Medical Association. Half of participants where asked about their wishes in a hypothetical case of cardiac arrest and the other half in a case of stroke. To see how older adults feel about potentially receiving tPA after a stroke, he and his colleagues analyzed data from a nationally-representative online survey of 1,100 people ages 50 and older. “That’s been the main cause for reluctance on the part of many physicians to use this medicine, particularly when the patient can’t engage in a conversation about the risks and benefits.” But there may be some patients who are harmed by the medication,” Chiong said. “If the medication is given early, say within the first three or four and a half hours, it doesn’t increase the risk of death. The medication comes with a risk of bleeding, including bleeding in the brain, so after too long a delay the potential benefits may no longer outweigh the risks. One reason is that tPA is time-sensitive and guidelines say it should only be given to patients who have had a stroke within the past few hours. The treatment remains underutilized, Chiong said, with less than 5 percent of stroke patients receiving clot-busting medication. In recent years, both the American Academy of Neurology and the American Heart Association/American Stroke Association have released statements supporting the use of tPA for stroke patients who are unable to consent, and when a family member is not present. “They might be unable to speak because of a stroke, or be unable to communicate, or in some cases they might not be aware of the fact that they’ve been debilitated by the stroke.” when patients are unable to speak for themselves,” he told Reuters Health. “There’s been a controversy within not just neurology but a number of the disciplines about how to manage this really difficult ethical situation. ![]() Winston Chiong.Ĭhiong led the new study at the University of California, San Francisco. But people who receive tPA or similar drugs tend to have better mental functioning after a stroke and are more likely to be able to live independently, according to Dr. The medication, tissue plasminogen activator, or tPA, typically does not save a patient’s life following a stroke. NEW YORK (Reuters Health) - About one-quarter of older adults would not want to receive clot-busting medication for a stroke if they arrived at the hospital unable to make the decision themselves, a new survey found.
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