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Thrombolytks worth consideration inmoke

THERAPY

Evidence for the efficacy of thrombolytics in acute ischaemic stroke is certainly encouraging enough to justify investigation in large randomised trials, possibly on the scale of the myocardial infarction trials, say Drs JM Wardlaw and CP Warlow from Western General Hospital, Edinburgh, Scotland.

Stroke is the third most common cause of death in the developed world and a truly effective treatment remains elusive. However, the 4 small randomised trials of thrombolytics conducted with the aid of CT scanning for diagnosis suggest that this approach may reduce the risk of death by 37%, and the risk of death or deterioration by 56%. Overall, open trials have shown some degree of recanalisation in 61 % of patients within 24 hours of symptom onset.

Concerns over an increased risk of haemorrhage with thrombolytic therapy have been expressed. However, Drs Wardlaw and Warlow suggest that this risk is not unacceptable with an estimated incidence of cerebral haematoma of 5% and of petechial haemorrhage of 10%.

Randomised trials of thrombolytics are currently underway in Italy, Australia and America.

Wardlaw 1M, Warlow CPO Thrombolysis in acute ischemic stroke: does it work? Stroke 23: 1826·1839, Dec 1992 1IlO17321l

9 Jan 1993 INPHARMA8 ISSN 0156-270319310109·00161$1.cxf' Adlslnternatlonsl Ltd