Tissue plasminogen activator and patients with acute ischemic stroke: The litigation landscape

Tissue plasminogen activator (tPA) is considered standard of care for acute ischemic stroke treatment, but some physicians withhold or delay this highly time-dependent therapy from stroke patients because they do not think it works well or they are worried about the adverse effects or fear medico-legal consequences. The authors sought to investigate whether litigation arises from physicians treating versus not treating acute ischemic stroke patients with tPA.

The authors examined closed cases from 1996 to 2020 in an online legal database, Westlaw, regarding alleged complaints for whether or not thrombolytic treatment was given for acute stroke.

Sixty-six relevant cases were identified. In all 66 cases, the plaintiffs sued for issues stemming from either failure to give tPA or a delay in giving tPA. In 77% of cases the verdict was in favor of the defendant. Only 1 lawsuit included intracerebral hemorrhage after tPA, but it was brought forth owing to delay in giving tPA; the verdict was in favor of the defendant.

It is more common for patients to sue physicians for not administering tPA in a timely fashion or at any point. Medicolegal risks of withholding or delaying tPA are clear, whereas we found no clear medicolegal risk to providing tPA when indicated.