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?
- “ENCHANTED: Low-Dose tPA Now a Viable Option in Stroke?”
- “ENCHANTED results challenge reduced alteplase dose in Asian stroke patients”
- “Low-Dose tPA Not as Effective, Even for Asians”
- “Lower Dose of Clot-Busting Drug Reduces Brain Bleeding”
- “Low-dose alteplase fails to prove noninferiority to standard dose, shows some benefit in stroke”
- “Low-Dose Alteplase Not as Effective as Standard-Dose in Acute Ischemic Stroke”
The question, simply, comes down to how easily one interprets “non-inferiority” – a point made nicely by Rory Spiegel in his post..."