Word: tpa
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Dates: during 1990-1999
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Dunn doctors boast that they are not tied to the controversial drug "formularies" used in managed-care to rein in doctors' drug choices. Cardiologist Ganapathy Ramanathan says he regularly prescribes a very expensive heart-attack drug called TPA, at thousands of dollars a dose, rather than the drug streptokinase, which is available for a fraction of the cost but has been found less effective in some studies. "I'm sure the hospital has lost a lot of money on many of my patients, but they've never told me about it," he says. Dunn contends it is more willing...
...care, vigorously disputes the notion that its treatment style is any less effective. "Just because you can stay twice as long at Dunn doesn't mean it's better health care," Birdzell says. He adds that Bedford Regional's drug-selection policies are not cost-driven. It prescribes both TPA and streptokinase, for instance, depending on the specifics of the patient's condition. As for specialists, Bedford Regional says its HMO patients see them when appropriate, even though their use is carefully monitored. Actually, Bedford Regional argues, its more modern approach can be better. For example, the hospital is starting...
Even stroke victims who, for one reason or another, cannot be given TPA can increase their chances of survival and recovery by getting to an emergency room swiftly. Doctors can still give them blood thinners that may dislodge a stroke-causing clot. The outcome of some bleeding strokes can also be markedly improved by surgical repair of the blood vessel that is leaking into the brain...
...being effective whether the stroke is caused by a clot or by internal bleeding. So far, however, they have worked only in experiments with laboratory animals, where they could be given within minutes after a stroke was induced. Clinical trials are under way to see whether, as with TPA, administering these drugs shortly after the stroke's occurrence produces better results...
...every stroke can be prevented, of course. That is why neurologists would like to develop better emergency treatments for stroke. The development of safe neuroprotective agents would allow paramedics to start protecting the brain as soon as they suspect someone is suffering from a stroke. Then doctors could administer TPA or other treatments the minute patients arrive at the emergency room. Some doctors point to the fact that emergency cardiac treatment has helped cut the rate of death from heart attack 30% over the past 20 years. "I think we can catch up to and surpass that for stroke," says...