Hazards of thrombolytic therapy for stroke: the real-world experience.

摘要

The evaluation of the randomized controlled trials of thrombolytic therapy for patients presenting with acute ischaemic stroke is complex as the studies included had multiple, and different, end-points, eligibility time windows and inclusion and exclusion criteria. For six controlled trials of therapy with tissue-type plasminogen activator (t-PA) used within the 3-h time window, for the combined end-point of death and significant disability, there is significant heterogeneity, making the most suitable patient population uncertain. Moreover, for the end-point of all-cause mortality, the summary odds ratio (OR) is 0.97 (95% confidence interval (CI) 0.69-1.36). Hence, on current evidence, an increased risk of mortality as great as 36% has not been excluded. In this context, the audit of thrombolytic therapy using t-PA for patients presenting with ischaemic stroke reported by Bray et al. is an important 'real-world experience'.