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Pomegranate Health
Pomegranate Health is a podcast about the culture of medicine. You'll hear insights from clinicians, researchers, and advocates as they tackle important questions — like how to make difficult clinical and ethical decisions without being influenced by bias, how to communicate better with patients and colleagues, and how to provide healthcare that’s both efficient and fair.
If you're a Fellow of the RACP, time spent listening can be counted toward your CPD hours. And if you're a Basic Physician Trainee, the [Case Report] series can help you prepare for your long case clinical exams.
This is also the home of [IMJ On-Air], featuring authors from the Internal Medicine Journal sharing their latest research. The [Journal Club] episodes give RACP researchers a space to talk through their work published in other academic journals. And for Basic Trainees, the [Case Report] series can help you prepare for your long case clinical exams.
Find out more at the website www.racp.edu.au/podcast and get in touch via the address podcast@racp.edu.au
Pomegranate Health
[Journal Club] Thrombolysis up to 24hr after ischaemic stroke
Thrombectomy for acute ischaemic stroke has undergone great advances in the last decade, but the expertise and technology is restricted to tertiary hospitals. Outside of large metropolitan centres, thrombolytic treatment can buy a patient time, but for almost 30 years the first line agent has remained unchanged.
Alteplase is an analog of the human tissue plasminogen activator which activates plasmin to dissolve fibrin blood clots. For many years it was assumed that alteplase should be administered within 3 hours of symptom onset, thus it was a big deal when in 2008, research showed that that window could be safely broadened out to four and a half hours.
Today’s guests have over the intervening years been pushing the envelope even further, in an effort to help the more than two thirds of stroke patients who present after that threshold. In this podcast, Professors Bruce Campbell and Mark Parsons discuss a trial of the relatively novel agent, tenecteplase. The publication in the New England Journal of Medicine showed that tenecteplase could improve patient outcomes even if administered up to 24 hours out from a large vessel occlusion. The researchers explain the steps that led up to their study, and the importance of perfusion imaging to identify candidates with salvageable brain tissue.
Key Reference
Tenecteplase for Ischemic Stroke at 4.5 to 24 Hours without Thrombectomy [NEJM. 2024]
Guests
Dr Duncan Austin PhD FRACP MRCP (Cabrini Health)
Professor Bruce Campbell PhD FRACP (Cabrini Health; Royal Melbourne Hospital; University of Melbourne)
Professor Mark Parsons PhD FRACP, FAAHMS (Sydney Neurointerventional Specialists; Consulting in Neurology, Maitland).
Production
Produced by Mic Cavazzini DPhil. Music licenced from Epidemic Sound includes ‘Things to Sort Out’ by Walt Adams and ‘the Appalachian Trail’ by Hunter Quinn. Image produced and copyrighted by RACP.
Editorial feedback kindly provided by RACP physicians Stephen Bacchi, Aidan Tan, Courtney Dowd, Saion Chaterjee and David Arroyo.
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