Predicted impact of intravenous thrombolysis
BMJ 2000; 320 doi: https://doi.org/10.1136/bmj.320.7240.1006 (Published 08 April 2000) Cite this as: BMJ 2000;320:1006
Patients who died or recovered fully should have been included in analysis
- Joris Berwaerts, lecturer in clinical pharmacology,
- Andrew McDonald Johnston, cardiovascular research fellow (AMcD.Johnston@arh.grampian.scot.nhs.uk),
- Mary-Joan Mary-Joan Macleod, lecturer in clinical pharmacology
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
- Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
- UCLA School of Medicine, Los Angeles, CA 90077, USA
- Department of Neurology, Bispebjerg Hospital, Bispebjerg bakke 23, DK-2400 Copenhagen, NV, Denmark
EDITOR—Jørgensen et al report a simulation of the impact of intravenous thrombolysis on prognosis for a general population of stroke patients.1 Although we do not argue with their conclusion that comparatively few patients with acute ischaemic stroke will benefit from thrombolytic treatment, we believe that their analysis of the data is flawed.
During their retrospective analysis Jørgensen et al identified patients who fulfilled the criteria for thrombolysis and then excluded patients who died or had a full recovery. They subsequently excluded the same groups of patients from the ideal scenario in which all patients were admitted within the time window for thrombolysis. Had thrombolysis actually been given, the outcomes for these patients would have been unknown at the time of administration. These patients should therefore have been included in the analysis.
References
- 1.↵
Another trial is needed
- Jerome R Hoffman, professor of medicine (jrh@ucla.edu)
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
- Acute Stroke Unit, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN
- Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen AB25 2ZD
- UCLA School of Medicine, Los Angeles, CA 90077, USA
- Department of Neurology, Bispebjerg Hospital, Bispebjerg bakke 23, DK-2400 Copenhagen, NV, Denmark
EDITOR—The paper by Jørgensen et al provides a small counterbalance to the enormous propaganda behind an expensive, minimally tested, and potentially harmful intervention.1 The real ratio of benefit to risk of thrombolytics for stroke may even be far worse than Jørgensen et al calculate, for the following reasons.
Firstly, even fewer …
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