Volume 188 - Issue 8
Tissue plasminogen activator for acute ischaemic stroke
Author: Daniel M Fatovich
Med J Aust 2008; 188 (8): 489. || doi: 10.5694/j.1326-5377.2008.tb01731.x
Published online: 21 April 2008
Published online: 21 April 2008
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.
References
- Davis SM, Hand PJ, Donnan GA. Tissue plasminogen activator for ischaemic stroke: highly effective, reasonably safe and grossly underused [editorial]. Med J Aust 2007; 187: 548-549.
- 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. 0_i1091826
- American Academy of Emergency Medicine. Position statement on the use of intravenous thrombolytic therapy in the treatment of stroke. Milwaukee, Wis: AAEM, 2002. http://www.aaem.org/positionstatements/thrombolytictherapy.php (accessed Feb 2008).