Letters Thrombolysis in acute ischaemic stroke

Authors’ reply to Wardlaw and Berge

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1795 (Published 07 April 2015) Cite this as: BMJ 2015;350:h1795
  1. Brian S Alper, vice president of evidence based medicine research and development, quality, and standards1,
  2. Meghan Malone-Moses, associate managing editor1,
  3. James S McLellan, associate managing editor1,
  4. Kameshwar Prasad, professor and head2,
  5. Eric Manheimer, Cochrane review author3
  1. 1DynaMed, EBSCO Health, EBSCO Information Services, Ipswich, MA 01938, USA
  2. 2Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
  3. 3Bahrain Branch of the Cochrane Collaboration, Awali, Bahrain
  1. balper{at}EBSCO.com

Wardlaw and Berge note the use of data from all thrombolytic trials and alteplase trials, and that distinguishing between these conclusions could be a source of confusion.1 Either way, we question the validity of “up to six hours” or “up to 4.5 hours” conclusions because:

  • Time from symptom onset could have such an influence on outcomes that uniform interpretation across these combined time windows is not clinically relevant or valid

  • The …

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