In response to amended Resolution 32 from the 2013 Council meeting, the ACEP Board of Directors instructed the Clinical Policies Committee to review the tPA for acute ischemic stroke policy, distribute the policy for 60 days of comments by the membership, conduct an updated literature search, and provide a recommendation to the Board regarding reconsideration of the policy.

The tPA policy was posted on the ACEP web site for a 60-day open comment period and notices were sent to the membership and chapters by multiple communication methods. A Clinical Policies tPA Subcommittee was formed, consisting of four committee members and the committee methodologist. All subcommittee members were vetted by an enhanced conflict of interest questionnaire.

The subcommittee conducted an updated literature search for articles since 2011. This yielded 1,124 candidate articles, which were reviewed. One hundred and thirty-six articles were considered appropriate for grading; each article was graded by two subcommittee members, with any grading differences being resolved by the methodologist. The Class I and Class II articles from the original tPA policy were also re-graded. All open comments (77 pages worth) were carefully reviewed and any evidence noted, resulting in the addition of seven articles: six graded as Class X and one graded as Class II.

Multiple subcommittee conference calls were conducted and the results were presented to the full Clinical Policies Committee at a face-to-face meeting on June 10, 2014. After four hours of discussion, the committee voted in favor of recommending an immediate update of the tPA policy, to be done by the Clinical Policies Committee, to the ACEP Board of Directors. This recommendation was presented to the Board on June 25, 2014, and approved.

Dr. Cantrill is an emergency physician and consultant at Denver Health Medical Center where he previously served as associate director of the department of emergency medicine for 18 years.  He is the interim chair of the Clinical Policies Committee.