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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, February 2, 2017

Systematic Review of stroke thrombolysis

St. Emlyn´s - February 2, 2017 - By Alan Grayson
"I think it’s probably fair to say that stroke physicians and emergency physicians disagree about the utility of thrombolysis in acute ischaemic stroke. They love it, probably because of its occasionally amazing effects in restoring an apparently dense hemiplegia with aphasia to almost normality. We hate it, because we see the effects of symptomatic intracranial haemorrhage and the early deaths as a result.
Its also probably fair to say that we disagree over our interpretation of the evidence. Despite thrombolysis being used in many forms and in small trials since the 1960s, it didn’t really gain prominence until the publication of the NINDS trial in 1995. This has been discussed elsewhere but to recap, in brief, it was a trial of human recombinant tissue plasminogen activator (tPA) versus placebo in presumed acute ischaemic stroke, given within 180 minutes of symptom onset. This showed improved outcomes on various functional scales, but a significantly increased rate of symptomatic intracranial haemorrhage and early mortality in those treated with tPA. Greater minds than mine have questioned not only the methodology and results of the NINDS trial (Hoffmann 2001, Mann 2002) but also the implementation of the trial in the real world (Katzan, 2000). There were also significant concerns over the involvement of the drug manufacturer in the process of authoring the manuscript..."