Hostname: page-component-7bb8b95d7b-s9k8s Total loading time: 0 Render date: 2024-09-25T15:48:22.714Z Has data issue: false hasContentIssue false

Tissue plasminogen activator for acute ischemic stroke: Is the CAEP Position Statement too negative?

Published online by Cambridge University Press:  21 May 2015

Jerome R. Hoffman*
Affiliation:
Professor of Medicine/Emergency Medicine, UCLA School of Medicine, Los Angeles, Calif
*
UCLA Emergency Medicine Center, 924 Westwood Blvd., Ste. 300, Los Angeles CA 90077; jrh@ucla.edu

Extract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Adapting information from research to clinical practice can be difficult, and we are often forced to decide whether benefits reported in selected trials are adequate to justify widespread application of the intervention studied. This is particularly problematic when the “evidence” is scanty, the degree of benefit apparently small (if real), and the treatment potentially dangerous. In addition, it is always important to consider whether community physicians can replicate the success described in research studies, which are typically performed by experts working in the controlled setting of a well-funded study.

Type
Controversies • Controverses
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.Canadian Association of Emergency Physicians Committee on Thrombolytic Therapy for Acute Ischemic Stroke. Thrombolytic therapy for acute ischemic stroke. CJEM 2001;3(1):812.CrossRefGoogle Scholar
2.American Heart Association. Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2000;102(Suppl I). Available: http://circ.ahajournals.org/content/vol102/suppl_1/#ECC_GUIDELINES (accessed 2001 June 02).Google Scholar
3.Tissue Plasminogen Activator for Acute Ischemic Stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333(24):15817.Google Scholar
4.Kay, R, Wong, KS, Yu, YL, Chan, YW, Tsoi, TH, Ahuja, AT, et al. Low-molecular-weight heparin for the treatment of acute ischemic stroke. N Engl J Med 1995;333(24):158893Google Scholar
5.Marler, JR, Tilley, BC, Lu, M, Brott, TG, Lyden, PC, Grotta, JC, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA stroke study. Neurology 2000;55:164955.Google Scholar
6.Jorgensen, HS, Nakayama, H, Kammersgaard, LP, Raaschou, HO, Olsen, TS.Predicted impact of intravenous thrombolysis on prognosis of general population of stroke patients: simulation model. BMJ 1999;319:2889.CrossRefGoogle ScholarPubMed
7.Hoffman, JR.Predicted impact of intravenous thrombolysis. Another trial is needed [letter]. BMJ 2000;320:1007.Google Scholar
8.Libman, RB, Wirkowski, E, Alvir, J, Rao, TH.Conditions that mimic stroke in the emergency department: implications for acute stroke trials. Arch Neurol 1995;52(11):111922.Google Scholar
9.Schriger, DL, Kalafut, M, Starkman, S, Krueger, M, Saver, JL.Cranial computed tomography interpretation in acute stroke: physician accuracy in determining eligibility for thrombolytic therapy. JAMA 1998;279:12937.CrossRefGoogle ScholarPubMed
10.Katzan, IL, Furlan, AJ, Lloyd, LE, Frank, JI, Harper, DL, Hinchey, JA, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA 2000; 283(19):11518.Google Scholar