Can quality-adjusted life-years and subgroups help us decide whether to treat late-arriving stroke patients with tissue plasminogen activator?

摘要

The amount of brain saved by recombinant tissue plasminogen activator (rtPA) is thought to increase with the size of the stroke and decrease with the time between symptom onset and drug administration. Meanwhile, the risk of death or disability caused by intracranial hemorrhage may increase with both stroke size and time. These tradeoffs underlie the question faced by clinicians as they treat stroke patients who, as most do, arrive too late for treatment within the 3-hour window: Do the diminishing benefits of rtPA outweigh the increasing risks?