Has enthusiasm overwhelmed judgement?
Although advocates of the use of tissue plasminogen activator (tPA) in acute ischaemic stroke suggest that this “is one of the most important advances in stroke medicine”,1 a recent Cochrane meta-analysis also supports “clinicians who choose . . . not to use the treatment at all”,2 and all three major emergency medicine associations in North America have declined to endorse it as “standard of care”.3
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