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Stroke remains among the top 4 causes of death in the United States and, despite advances in inpatient care and rehabilitation, the leading cause of severe disability. Furthermore, despite being a proven effective therapy, tissue plasminogen activator (tPA) use remains dramatically low, used in ∼2% of all stroke patients in a community setting.1 In this issue of Neurology®, Shamy and Jaigobin2 address the use of tPA in appropriate clinical settings and neurologists' rationale for their decisions. Given the mortality and morbidity associated with stroke, the data for substantial benefit with tPA use, and US Food and Drug Administration approval, the limited use of tPA raises ethical and legal concerns.
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- © 2013 American Academy of Neurology
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