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Review of Tissue Plasminogen Activator, Ischemic Stroke, and Potential Legal Issues
Bryan A. Liang, MD, PhD, JD;
Robert Lew, PhD;
Justin A. Zivin, MD, PhD
Arch Neurol. 2008;65(11):1429-1433.
The use of tissue plasminogen activator in ischemic stroke is controversial. Many practicing physicians believe that its usefulness is established, while others, including professional specialty societies, are less sanguine. A review of the literature appears to show that the use of tissue plasminogen activator is efficacious and can result in highly improved outcomes for a majority of eligible patients. These findings may implicate important potential legal issues. Informed consent concerns and, potentially, medical malpractice claims may result, particularly in the context of evidence-based practice, pay for performance, and the currently limited use of tissue plasminogen activator for eligible patients.
Author Affiliations: Institute of Health Law Studies, California Western School of Law, San Diego (Dr Liang); San Diego Center for Patient Safety (Dr Liang), Department of Anesthesiology (Dr Liang), and Department of Neurosciences (Dr Zivin), University of California San Diego, School of Medicine, La Jolla (Drs Liang and Zivin); Graduate School of Public Health, College of Health and Human Services, San Diego State University (Dr Liang); Massachusetts Veterans, Epidemiology Research and Information Center, Boston (Dr Lew); and San Diego Veterans Affairs Medical Center, La Jolla (Dr Zivin).
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