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Stephenson and colleagues have written a clear and well referenced article, taking the view that urban prehospital thrombolysis is unlikely to be either clinically or cost effective.1 Some of their arguments in support of this assertion, such as the idea that urban prehospital times are very short or that complications are a significant concern, I have already addressed. We both agree that one of the main problems in this field is a lack of research, and until adequately powered studies of paramedic administered urban prehospital thrombolysis are published we must rely upon educated guesswork and extrapolation. Such studies will also …