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Edited by Jim Wardrope; this scan coordinated by Rob Russell
Thrombolysis for acute ischaemic stroke
Thrombolysis for acute ischaemic stroke remains a controversial area. The National Institute of Neurological Disorders and Stroke study (NINDS)1 trial reported improved long term neurological function when patients were treated with intravenous tissue type plasminogen activator (iv tPA) within three hours of symptom onset. This benefit was set against an increased risk of intracerebral haemorrhage (ICH). Further studies have produced similar results, although others have not shown any benefit. Doubts remain regarding the safety and efficacy in routine clinical use outside specialist centres. The debate continues in this contentious area and two contrasting papers show different positions and results. It would be a useful postgraduate educational exercise to compare and contrast these studies in detail and try to explain the very different findings in these trials. What are the main conclusions that you draw from this issue? Prize for the best critique that is e-mailed to the Journal scan editor by 22 September 2000.
Use of tissue-type plasminogen activator for acute ischaemic stroke—the Cleveland area experience
Objectives—To assess the rate of tPA use, the incidence of symptomatic ICH, and patient outcomes in a large urban community (Cleveland, Ohio).
Design—Prospective cohort study over one year.
Patients—3948 patients admitted to study hospitals with a primary diagnosis of acute ischaemic stroke.
Methods—Structured chart review of all stroke patients admitted to all of the 29 Cleveland area hospitals.
Outcome measures—Rate of tPA use: occurrence of symptomatic ICH in patients given tPA: proportion of those treated with tPA where treatment varied from national protocols: inhospital mortality in patients treated with tPA compared with those not thrombolysed, comparison of mortality and length of stay between a case-control matched group.
Results—3948 patients with ischaemic stroke were identified. Altogether 674 were admitted within three hours of symptom onset. Seventy (1.8% of total, 10.4% …