Risk assessment is based on patient-related factors such as atrial fibrillation (“A Fib”), carotid artery disease, a history of transient ischemic attacks (“TIAs”) or stroke, hypercoagulable states such as heparin-induced thrombocytopenia (“HIT syndrome”), high blood pressure, or patent foramen ovalis (communication between the chambers of the heart). When a patient is at increased risk of stroke or cerebrovascular accident (“CVA”), a number of treatment options are available.
In some instances, treating the underlying condition can resolve the risk of CVA. For example, when a patient’s carotid arteries are occluded by 70% or more on imaging, a surgical procedure called endarterectomy can be performed to restore patency to the vessel. In other cases, treatment comes in the form of anticoagulation, such as coumadin, warfarin or heparin, or antiplatelet medications, such as aspirin or Plavix, to minimizing the clotting capacity of blood.
Another example involves posterior reversible encephalopathy syndrome (“PRES”). If untreated, PRES can result in CVA and often blindness. PRES is seen in pre-eclamptic/eclamptic women and requires aggressive blood pressure management along with treatment of preeclampsia/eclampsia (i.e., emergent delivery of the baby).
Once a CVA occurs, prompt treatment is necessary. Treatment of CVA is time-sensitive, meaning that delays of even a few hours can render treatment options inadvisable or dangerous. Delayed treatment is common basis for medical malpractice claims. Treatment options depend upon the severity of the CVA and its source, but may include anticoagulation, the use of tissue plasminogen activator (“tPA”), stenting, bypass, or balloon angioplasty.
The use of tPA is often the subject of litigation. The American Heart Association (AHA) published criteria for the use of tPA. As of 2009 guidelines, tPA may now be used up to 4.5 hours after onset of CVA. A retrospective statistical review shows that tPA is effective 60% of the time when timely administered.
