Use thromboIytics cautiously in patients with stroke

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While recent stroke generally remains a contra­indication for the use of thrombolytics, the potential of several of these agents in treating acute ischaemic stroke is currently being investigated.

Against this background, and based on the fact that the US FDA has not approved the use of thrombolytic agents in this indication. clinicians from Duke University Medical Center in Durham. US, urge the medical community to adopt appropriate guidelines in this conteltt. Dr Mark J Alberts and colleagues fear that some patients with stroke may be at risk of serious complications associated with administration of thrombolytics, as a consequence of physicians' lack of experience in this field. In the interim, they suggest the following guidelines for treating patients with stroke. • Patients and their families should be informed of

the potential risks associated with the use of thrombolytics.

• Such 'off-study' protocols should be approved by the hospital's institutional review board.

• Only physicians who are trained, or who have expertise, in the use of thrombolytics in patients with stroke should administer these agents.

• Thrombolytic agents should only be administered in facilities capable of treating any of the complications that may arise. Availability of a vascular neurologist, a neurosurgeon, an interventional newo-radiologist and a coagulation specialist may enhance safe treatment. Dr Alberts and coUeagues urge the adoption of a

cautious approach until convincing data that support the efficacy of thrombolytics in this indication are available.

Alberta MJ. Cic>ldsU:in LB. SlEUth T. G\Iiddincs oolbc _ ofthrotd:lolytic: ~ in , lJOU.loumo1 oflhe Amcriun Medi(:11 AssocilItioII 2704, 218. 19 Jull99S

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