Administering t-PA

Running head: ADMINISTERING T-PA 1
Administering t-PA
Name
Institutional Affiliation

ADMINISTERING t-PA 2
ADMINISTERING T-PA
PICOT Statement:
Do patients with acute ischemic stroke that receive tissue plasminogen activator (t-PA)
versus not receiving thrombolytic agents result in better neurological outcome within 4.5 hours
from symptom onset?"
Clinical Problem
The main clinical problem for this essay is to determine whether the treatment of acute
ischemic stroke patients using t-PA or not leads to better neurological outcome. An alteplase (t-
PA//retavase) is a thrombolytic agent alongside reteplase (r-PA/retavase) and other agents which
is a drug that can dissolve a thrombus or clot and reopen a vein or an artery. This agent can be
used to treat stroke, heart attack, and deep vein thrombosis, occlusion of a peripheral artery,
pulmonary embolism and indwelling catheter. It is a serine protease and converts plasminogen to
plasmin hence breaking down fibrinogen and fibrin as well as dissolve a clot (Lobotesis et al.,
2016).
Nonetheless, t-PA for acute ischemic stroke stays significantly underutilized despite its
approval in 1996 by the US FDA. Three reasons account for this underutilization rates of t-PA
including poor education of patients, perceived risks of legal liability by physicians from adverse
outcomes, and inadequate reimbursement. The new addition of diagnosis-linked grouping code
559 shall give higher payment for patients with stroke treated with t-PA (Mohedano et al., 2017).
Evidence-Based Solution
Administering t-PA has been shown to enhance recovery from ischemic stroke symptoms
by up to fifty percent with a severe low rate of complication. Treating ischemic stroke patients
with intravenous t-PA has been linked to enhanced long-run survival. Schmitz et al. (2014)

ADMINISTERING t-PA 3
studied 4292 ischemic strokes with 2146 receiving t-PA while 2146 propensity score receiving
matched non-intravenous t-PA. There was a follow-up for a median of 1.40 years. The result
showed that treatment with intravenous t-PA was linked with reduced risk of long-run mortality.
The long-run ischemic stroke recurrent and main bleeding never differed substantially between
the t-PA treated and non-treated groups. The t-PA remains an efficient and effective treatment
for ischemic stroke patients (Schmitz et al., 2014). Various studies have examined functional
outcome alongside mortality at three months following intravenous t-PA treatment and
established that treatment enhanced neurological outcomes but no influence on mortality. The t-
PA in routine clinical practice is connected to improved long-run survival which stresses the
need for ongoing efforts to increase awareness of stroke and to make sure effective organization
alongside acute stroke treatment availability.
Nursing Intervention
The nurses intervene to ischemic stroke patients using tissue plasminogen activator (t-
PA) to improve neurological outcomes. However, the intervention is slowed due to three barriers
presented above. The surveys in the United States population showed that the stroke remained
poor comprehended. Despite the t-PA's efficacy besides cost-effectiveness, treating ischemic
stroke using t-PA still stays underutilized. Nursing intervention needs to go beyond
administering t-PA but focus on increasing patients' awareness to ensure patients have sufficient
information regarding the benefits of t-PA (Ma et al., 2016).
The fear of physicians of being legally liable for t-PA administration should be dispelled
through improved and accurate diagnoses to enhance its use. Further, there is a need for adequate
reimbursement (Lyden, 2015). Nursing can also intervene by increasing education efforts to
boost awareness. Physicians need to be informed that legal risk might be significant for failure to