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Letters Thrombolysis in acute ischaemic stroke

Cochrane reviewers’ response to Alper and colleagues’ analysis of thrombolysis in acute ischaemic stroke

BMJ 2015; 350 doi: (Published 07 April 2015) Cite this as: BMJ 2015;350:h1790
  1. Joanna Wardlaw, professor and honorary consultant neuroradiologist1,
  2. Eivind Berge, professor2
  1. 1Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh EH16 4SB, UK
  2. 2Department of Internal Medicine, Oslo University Hospital, NO-0407 Oslo, Norway
  1. joanna.wardlaw{at}

Alper and colleagues question the validity of the Cochrane review of thrombolytic treatment in stroke and our conclusion that treatment improves outcome if given up to 4.5 hours after stroke.1 They find the review confusing, but fail to acknowledge that the review includes 25 years’ worth of data from trials of several different thrombolytic drugs, not just alteplase.

The review clearly distinguishes between “thrombolytic therapy” meaning all drugs considered …

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