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Acute ischaemic stroke

BMJ 2000; 321 doi: (Published 29 July 2000) Cite this as: BMJ 2000;321:299

Thrombolysis for acute ischaemic stroke works

  1. Michael D Hill (, clinical stroke fellow,
  2. Philip A Barber, clinical stroke fellow,
  3. Andrew M Demchuk, assistant professor,
  4. Alastair M Buchan, professor
  1. Department of Clinical Neurosciences, University of Calgary, Stroke Research Office, Foothills Hospital, Calgary, AB T2N 2T9, Canada
  2. Division of Stroke Medicine, University of Nottingham, City Hospital Campus, Nottingham NG5 1PB

    EDITOR—We disagree with the thrust of Gubitz and Sandercock's interpretation of the evidence for treatment of acute ischaemic stroke.1 The meta-analysis that they quote includes three different thrombolytic agents, different time windows, and different doses.2 There may be no statistical evidence of heterogeneity of treatment effect, but there are clinical grounds to believe that these factors make for critically important differences.

    In the same meta-analysis the more homogeneous data drawn from the three trials that treated patients with intravenous alteplase within three hours of onset are also reported. A major treatment effect is observed, with an odds ratio of 0.55 (95% confidence interval 0.42 to 0.72) in favour of treatment. These patients include those who had early intracerebral haemorrhage. In this 0–3 hour group there is no increased mortality.

    The same analysis for the streptokinase trials shows no benefit but is impaired by the small numbers of patients …

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