To the Editor: Waxman’s prompt recovery after a stroke was probably a stroke of luck,1 unless perhaps Saint Mary MacKillop was involved. Amid the conflicting evidence on the effect of thrombolysis on recovery in ischaemic stroke, one fact is beyond doubt — thrombolysis gives no greater improvement at 24 hours than placebo.2 It is the various measures of recovery at 3 months, and the risks of adverse outcomes from protocol violations in administering thrombolysis, that are less clear.
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- Bankstown-Lidcombe Hospital, Sydney, NSW.
- 1. Waxman BP. A stroke of luck ... or just the ideal model of care? Med J Aust 2010; 193: 468. <eMJA full text> <MJA full text>
- 2. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581-1587.
- 3. Hacke W, Kaste M, Bluhmki E, et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischaemic stroke. N Engl J Med 2008; 359: 1317-1329.
- 4. Ahmed N, Wahlgren N, Grond M, et al, for the SITS investigators. Implementation and outcome of thrombolysis with alteplase 3–4·5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 2010; 9: 866-874.
- 5. Simpson MA, Dewey HM, Churilov L, et al. Thrombolysis for acute stroke in Australia: outcomes from the Safe Implementation of Thrombolysis in Stroke registry (2002–2008). Med J Aust 2010; 193: 439-443. <eMJA full text> <MJA full text>