Tuesday, June 7, 2016


University of Texas - Houston
Emergency Medicine Literature of Note - June 6, 2016 - Posted by Ryan Radecki
"I am probably the last person to comment on ENCHANTED, the trial testing low-dose vs. standard-dose tPA in “Asians”. When it was released, to some fanfare in the New England Journal of Medicine, I had little to say – it is, frankly, a rather bland contribution to the science. What has been fascinating, however, is the unusually divergent interpretation of the results. To wit, the accompanying editorial in the NEJM states:
“ENCHANTED provides no compelling evidence for using low-dose alteplase 
for acute ischemic stroke in Asian or other populations on the basis of 
safety considerations or clinical outcomes.”
This is a relatively reasonable interpretation of the results – hinging on the word “compelling”. No one’s hearts are to be set a-flutter over these results, but that does a disservice to the ultimate clinical question of which dose is appropriate. The lay press, however, is here to clear things up – or is it?
The question, simply, comes down to how easily one interprets “non-inferiority” – a point made nicely by Rory Spiegel in his post..."