Thrombolysis for acute ischemic stroke: does it work?—the con position

摘要

Thrombolysis for acute ischemic stroke (AIS) hasbecome mainstream therapy, despite the scientific evidence rather than because of it. Careful scrutiny of theliterature demonstrates that it has proven harm but noclear benefit, because of the sheer paucity of hard evidence supporting its use. There are only two largerandomized controlled trials (RCTs) showing benefitfor thrombolysis, and nine large RCTs that failed toshow any significant difference to placebo (four werestopped early due to excess harm). This is in starkcontrast to the clear mortality benefit for thrombolysisin six out of eight large RCT for myocardial infarction.1Both systematic and non-systematic reviews of thrombolysis for AIS are severely biased by the inappropriateinclusion of heterogeneous studies, to the extent thattheir positive conclusions can be reversed simply byeliminating those studies. The remainder of oftenquoted evidence in favour of thrombolysis is eitheruncontrolled monitoring data or hypothetical conjecture, neither of which answers the question ofefficacy.