Examining the role of thrombolytics in acute stroke
VIEWS & REVIEWS
It remains 'difficult' if not 'impossible' to clearly define a risk:benefit ratio for use of thrombolysis in individual patients with acute stroke, says Professor Julien Bogousslavsky from the Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
He notes that trials investigating the use of thrombolytics (streptokinase or alteplase) in the treatment of acute ischaemic stroke have produced conflicting results; some demonstrate improved functional outcome, while others demonstrate increased rates of mortality and brain haemorrhage. * Selection criteria differ
Professor Bogousslavsky wonders if some of the disparity between the trial results may be due to the different criteria employed to select patients in the various trials. He comments that future trials on thrombolysis in stroke should attempt to determine which patients may benefit most from this therapy, and that it would be premature to generalise thrombolytic therapy to all patients admitted to hospital within 3 hours of stroke onset.
Professor Bogousslavsky also emphasises the need to consider acute stroke as a medical emergency requiring prompt medical attention. Ideally, patients should be selected within the first few hours of stroke onset as having potential for recovery or improvement. * See /npharma 977: 5, 11 Mar 1995; 800314276, /npharma 1017: 14, 16Dec 1995; 800314851 and/npharma 1018: 12, 23 Dec 1995; 8003148fiJ . . Bogousslavsky 1. lbrombolysis in acute stroke: defining the risk to benefit ratio for individual patients remains impossible. British Medical loumal313: 640-641, 14 sep 1996 800471084