Tissue plasminogen activator for acute ischaemic stroke

James C Hurley
Med J Aust 2008; 188 (8): . || doi: 10.5694/j.1326-5377.2008.tb01729.x
Published online: 21 April 2008

To the Editor: The recent report on the use of a stroke thrombolysis protocol by Batmanian and colleagues1 raises many issues. The most recent guidelines regarding thrombolytic therapy for ischaemic stroke recommend that “If thrombolytic therapy is to be used . . . consultation with a neurologist or stroke physician is essential before instigating therapy. Strict adherence to the inclusion and exclusion criteria is important . . .”2 Hence, I find the integral role of a neurologist in Batmanian and colleagues’ protocol reassuring.

  • Internal Medicine Service, Ballarat Health Services, Ballarat, VIC.


  • 1. Batmanian JJ, Lam M, Matthews C, et al. A protocol-driven model for the rapid initiation of stroke thrombolysis in the emergency department. Med J Aust 2007; 187: 567-570. <MJA full text>
  • 2. Neurology Expert Group. Therapeutic guidelines: neurology, version 3. Melbourne: Therapeutic Guidelines Limited, 2007.
  • 3. Whiteley W, Lindley R, Wardlaw J, Sandercock P, on behalf of the IST-3 Collaborative Group. Third International Stroke Trial. Int J Stroke 2006; 1: 172-176. (accessed Mar 2008).
  • 4. Wardlaw JM, del Zoppo G, Yamaguchi T, Berge E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2003; (3): CD000213.
  • 5. Hurley JC. Hazards of thrombolytic therapy for stroke: the real-world experience [letter]. Intern Med J 2007; 37: 348-349.
  • 6. 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: 1581-1587.
  • 7. Koziol JA, Feng AC. On the analysis and interpretation of outcome measures in stroke clinical trials: lessons from the SAINT I study of NXY-059 for acute ischemic stroke. Stroke 2006; 37: 2644-2647.
  • 8. Reed SD, Cramer SC, Blough DK, et al. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke 2001; 32: 1832-1840.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.