In reply: We welcome the opportunity to respond to issues raised by Hurley and Toncich. Australian, United States and European stroke guidelines based on level 1, grade A evidence recommend intravenous recombinant tissue plasminogen activator (IV-rtPA) for patients with acute ischaemic stroke (AIS) who meet specific inclusion criteria and present within 3 hours of AIS onset.1,2 Recombinant tPA is approved for this indication by the Therapeutic Goods Administration.
The full article is accessible to AMA members and paid subscribers. Login to read more or purchase a subscription now.
Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.
- 1 St Vincent’s Hospital, Sydney, NSW.
- 2 University of New South Wales, Sydney, NSW.
- 1. Adams HP Jr, Del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke 2007; 38: 1655-1711.
- 2. National Stroke Foundation. Clinical guidelines for acute stroke management. Melbourne: NSF, 2007. http://www.strokefoundation.com.au/news/welcome/clinical-guidelines-for-acute-stroke-management (accessed Feb 2008).
- 3. Wardlaw JM, del Zoppo G, Yamaguchi T, Berge E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2003; (3): CD000213.
- 4. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369: 275-282.
- 5. Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 2004; 61: 346-350.
- 6. Ingall TJ, O’Fallon WM, Asplund K, et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke 2004; 35: 2418-2424.
- 7. 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.
- 8. Hill MD, Buchan AM; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005; 172: 1307-1312.