Litigation Regarding tPA and Stroke

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To the Editor:

I suggest there is another factor involved in the over-representation of “failure to treat” cases involving tPA and stroke, reported by Liang and Zivin in the August 2008 issue of Annals.¹ That factor is “informed consent.”

I would expect that those patients who actually did receive thrombolytic therapy for their stroke were the recipients of truly informed consent which laid out the risks and benefits of treatment prior to administration of the drug. They would therefore have less grounds for a lawsuit. On the contrary, those patients whose physician either chose not to treat or were presented the option of tPA in a negative light are less likely to have been the beneficiaries of truly informed consent, if they received such counsel at all.

I would be interested in the authors' view of the role of informed consent in the cases they reviewed.

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Reference 

1. Liang BA, Zivin JA. Empirical characteristics of litigation involving tissue plasminogen activator and ischemic stroke. Ann Emerg Med. 2008;52:160–164
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