Strokes and net clinical benefit.
The need for careful assessment of stroke incidence in a trial comparing highly effective thrombolytic regimens was recognised in the design of the GUSTO trial. There was a gradation of stroke incidence from 1.22% in the streptokinase (SK) and subcutaneous heparin group, to 1.4% in the SK and intravenous heparin group, 1.55% in the tissue plasminogen activator (t-PA) and intravenous heparin group and 1.64% in the combination t-PA and SK group. The concept of net clinical benefit was developed to balance the adverse effect of stroke with the benefit of mortality reduction. On this analysis, the net clinical benefit favoured the accelerated t-PA regimen over the SK regimens.
White
H
H
Green Lane Hospital, Auckland, New Zealand.
D000368:Aged; D002561:Cerebrovascular Disorders / Q000139:chemically induced*; D005260:Female; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007275:Injections, Intravenous; D007279:Injections, Subcutaneous; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use
D006493:Heparin; D013300:Streptokinase; D010959:Tissue Plasminogen Activator