Thrombolysis in Acute Ischemic Stroke: Does It Work?

Background This article is presented to provoke further discussion regarding the use of thromboly drugs to treat acute ischemic stroke. Summary of Review Overview analysis of the six randomized trials of thrombolysis in acute ischer stroke available in the world literature shows a 20% increase in the odds of death and a 30% reduction the odds of death or deterioration (both with wide confidence intervals, neither result significant) af thrombolytic treatment for acute ischemic stroke. Exclusion of the two trials conducted without I benefit of computed tomographic scanning shows a 37% reduction in the odds of death (95% confidence interval, 74% reduction to 40% excess) and a significant reduction of 56% in the odds of death or deterioration after thrombolytic treatment (95% confidence interval, 20–76% reduction; 2p = 0.007). Analysis of all published studies (randomized and nonrandomized) shows that there does not appear to be an excess risk of hemorrhagic transformation of the cerebral infarct or of severe edema formation. Conclusions We believe the present evidence is sufficiently encouraging to warrant proper testing of thrombolysis in sufficiently large and well-designed randomized clinical trials to influence clinical practice.

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