Q J Med 2003; 96: 179-181
© 2003 Association of Physicians
Editorial |
Stroke: beyond thrombolysis and back to basics
Department of Geriatric Medicine, University of Newcastle upon Tyne e-mail: chris.gray@chs.northy.nhs.uk
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Thrombolysis with recombinant tissue plasminogen activator (rTPA) is a new but controversial treatment for acute ischaemic stroke.1,2 Despite continuing debate about the safety and efficacy of rTPA, it is likely that its use in acute stroke patients will increase, albeit for highly selected patients. And therein lies the problem, because unlike myocardial infarction, where simple guidelines identify those for whom maximum treatment benefit may be achieved, with stroke the risk/benefit ratio is much less clear. Indeed, even with advanced neuroradiological imaging, it is still not clear which patients may obtain maximal benefit.3 In CT-proven ischaemic stroke, thrombolysis should ideally be administered within the first 3 h and probably no later than 6 h after symptom onset.2 While recent UK evidence suggests that 37% of acute stroke patients already present to hospital within 3 h of symptom
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