Reactions 1468, p2 - 7 Sep 2013 Is thrombolysis worth the risks in patients with stroke? Thrombolysis for stroke has been "consistently found" in randomised trials to be associated with a greater risk of intracranial haemorrhage and early death than placebo, say Professor Simon GA Brown and Associate Professor Stephen PJ Macdonald from University of Western Australia, Perth, Australia, in the BMJ. Indeed, Brown and Macdonald assert that "we can say for certain that thrombolysis harms some patients early, including some who might otherwise have made a good recovery". They contend that stroke is a "complex entity", and that effective treatment "requires more than trying to open a blocked artery". Professor Graeme J Hankey, also from University of Western Australia, counters this view by noting that large observational studies have found that the efficacy of thrombolysis reported in clinical trials "translates into comparable effectiveness and acceptable safety" in clinical practice. He concedes that, while thrombolysis is associated with serious and potentially fatal risks in some patients, there is evidence for its use, clinically and cost effectively, in "appropriately selected patients". Hankey suggests that clinicians should "urgently assess all patients presenting with suspected acute stroke", and consider thrombolysis in those who meet the relevant criteria, and who "consent to accepting the risks of treatment for potentially greater benefit". Brown SGA, et al. Do risks outweigh benefits in thrombolysis for stroke? BMJ 347: 29 Aug 2013. Available from: URL: http://dx.doi.org/10.1136/ bmj.f5215 803092449 1 Reactions 7 Sep 2013 No. 1468 0114-9954/13/1468-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved

Is thrombolysis worth the risks in patients with stroke?

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Reactions 1468, p2 - 7 Sep 2013

Is thrombolysis worth the risks inpatients with stroke?

Thrombolysis for stroke has been "consistently found"in randomised trials to be associated with a greater riskof intracranial haemorrhage and early death thanplacebo, say Professor Simon GA Brown and AssociateProfessor Stephen PJ Macdonald from University ofWestern Australia, Perth, Australia, in the BMJ.

Indeed, Brown and Macdonald assert that "we can sayfor certain that thrombolysis harms some patients early,including some who might otherwise have made a goodrecovery". They contend that stroke is a "complex entity",and that effective treatment "requires more than tryingto open a blocked artery".

Professor Graeme J Hankey, also from University ofWestern Australia, counters this view by noting thatlarge observational studies have found that the efficacyof thrombolysis reported in clinical trials "translates intocomparable effectiveness and acceptable safety" inclinical practice. He concedes that, while thrombolysisis associated with serious and potentially fatal risks insome patients, there is evidence for its use, clinically andcost effectively, in "appropriately selected patients".Hankey suggests that clinicians should "urgently assessall patients presenting with suspected acute stroke", andconsider thrombolysis in those who meet the relevantcriteria, and who "consent to accepting the risks oftreatment for potentially greater benefit".Brown SGA, et al. Do risks outweigh benefits in thrombolysis for stroke? BMJ347: 29 Aug 2013. Available from: URL: http://dx.doi.org/10.1136/bmj.f5215 803092449