To the Editor: The report by Leyden and colleagues highlights the value of examining the total experience of stroke thrombolysis in one population.1 The results are devastating: protocol violations in more than a third of cases (consistent with other reports of up to 50%2), and a 10% symptomatic intracranial haemorrhage (ICH) rate (representing a number needed to harm [NNH] of 10). As a clinician, I would be “gutted” if my treatment harmed every 10th patient. The 22% mortality at 3 months is consistent with real-world evidence that stroke thrombolysis increases mortality.3
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- Royal Perth Hospital, University of Western Australia, Perth, WA.
- 1. Leyden JM, Chong WK, Kleinig T, et al. A population-based study of thrombolysis for acute stroke in South Australia. Med J Aust 2011; 194: 111-115. <MJA full text>
- 2. Katzan IL, Furlan AJ, Lloyd LE, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA 2000; 283: 1151-1158.
- 3. Dubinsky R, Lai SM. Mortality of stroke patients treated with thrombolysis: analysis of nationwide inpatient sample. Neurology 2006; 66: 1742-1744.
- 4. Smith BJ. Thrombolysis for acute stroke in Australia [letter]. Med J Aust 2011; 194: 212. <MJA full text>
- 5. Mosely M. Is tPA study intentionally deceptive? Emerg Med News 2009; 31: 5-6.
- 6. Newman D. Thrombolytics for acute ischemic stroke. The NNT Group, 2010. http://www.thennt.com/thrombolytics-for-stroke (accessed Mar 2011).
- 7. Ioannidis JP. Why most published research findings are false. PLoS Med 2005; 2: e124.