In reply: We were delighted to hear of Waxman’s “miraculous” recovery, and admire the world-class standard of stroke care which was delivered at The Alfred.1 The Australian data in the Safe Implementation of Thrombolysis in Stroke (SITS) database up to 2008 included tertiary referral centres and outer metropolitan hospitals, and centres with varying experience of using recombinant tissue plasminogen activator (rt-PA) in clinical practice. There was no difference in outcomes according to experience of the treating centres. We believe that the non-trial clinical data presented in our article are a realistic indication of expected outcomes for all patients receiving thrombolysis for stroke in Australia.
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- 1 Department of Neurology, Austin Health, Melbourne, VIC.
- 2 John Hunter Hospital, Newcastle, NSW.
- 1. Waxman BP. A stroke of luck.. or just the ideal model of care? Med J Aust 2010; 193: 468. <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. Brown DL, Johnston KC, Wagner DP, Haley EC. Predicting major neurological improvement with intravenous recombinant tissue plasminogen activator treatment of stroke. Stroke 2004; 35: 147-150.