Proposed US stroke centres under fire for planned use of alteplaseBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7409.247 (Published 31 July 2003) Cite this as: BMJ 2003;327:247
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The majority of people who have a stroke are not young previously fit
adults but elderly. What both groups have in common is the difficulty in
understanding even basic risk and benefit information. In older
patients there ought to be a concern about the use of thrombolysis in the
presence of cerebral microhaemorrhages, a finding that is present in
around 6% of healthy older patients and likely to be higher in those with
vascular disease. These microhaemorrhages are of relevance as they can
mark people out as having increased risk from thrombolysis.
The people who are advocating this legislation should be able to
explain to the public what would happen to 100 people at the end of 30
days or a year who present with each category of stroke (POCI, PACI, LACI,
TACI)and modified Rankin score (1-5 - no need for 0 or 6). Easy to
understand risk and benefit information for thrombolysis is required to
enable patients to give consent and make informed treatment choices rather
than the introduction of legislation to allow doctors to do what they feel
is in a person's best interest.
Thrombolysis may be the best option in some cases but care is needed
in extrapolating data obtained in trial conditions to real life, to all
strokes, and to people of all ages.
 Fuller R, Dudley N, Blacktop J.
How informed is consent? Understanding of pictorial and verbal probability
information by medical patients.
Postgrad Med J 2002;78:543 - 544
 Roob G, Schmidt R, Kapeller P et al.
MRI evidence of past cerebral microhaemorrhages in a healthy elderly
Neurology 1999;52:991 - 994.
 Kidwell CS, Saver JL, Villablanca J et al.
Magnetic resonance imaging detection of microbleeds before thrombolysis.
Stroke 2002;33:95 - 98
Competing interests: No competing interests