Thrombolysis in acute ischemic stroke: does it work?
BACKGROUND
This article is presented to provoke further discussion regarding the use of thrombolytic drugs to treat acute ischemic stroke.


RESULTS
Overview analysis of the six randomized trials of thrombolysis in acute ischemic stroke available in the world literature shows a 20% increase in the odds of death and a 30% reduction in the odds of death or deterioration (both with wide confidence intervals, neither result significant) after thrombolytic treatment for acute ischemic stroke. Exclusion of the two trials conducted without the 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.
Wardlaw
J M
JM
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Warlow
C P
CP
D000208:Acute Disease; D000368:Aged; D001929:Brain Edema / Q000209:etiology; D002545:Brain Ischemia / Q000628:therapy*; D002543:Cerebral Hemorrhage / Q000209:etiology; D002561:Cerebrovascular Disorders / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D005343:Fibrinolytic Agents