To the Editor: I found it ironic to read the recent editorial by Davis and colleagues endorsing the use of tissue plasminogen activator (tPA) therapy for stroke patients.1 The irony relates to the fact that a week later I attended the annual scientific meeting of the Australasian College for Emergency Medicine, where data were presented (Hoffman J. New information on the use of tPA in acute ischaemic stroke. 24th Annual Scientific Meeting of the Australasian College for Emergency Medicine; 2007 Nov 25–30; Gold Coast, Qld) that cast strong doubt on the conclusions derived from the NINDS trial.2

There are further objections to the claim that the value of tPA has been adequately proven,3 none of which are remotely addressed by the editorial.

As an emergency physician, this dichotomy of opinion is frustrating. There is obviously conflicting evidence, which usually means that data are insufficient. Hence, until more research is completed, especially clinical trials that replicate the original NINDS study, the claim of Davis et al that tPA is “highly effective, reasonably safe and grossly underused”1 is inappropriate.