Volume 194 - Issue 8
A population-based study of thrombolysis for acute stroke in South Australia
Authors: Tim Kleinig, James M Leyden, Andrew Lee and Jim Jannes
Med J Aust 2011; 194 (8): 431-432. || doi: 10.5694/j.1326-5377.2011.tb03050.x
Published online: 18 April 2011
Published online: 18 April 2011
In reply: To a carpenter, everything looks like a nail, and to a stroke thrombolysis sceptic, every study seems to confirm their opinion. A result cannot be “clinically important” yet statistically not so. We found no difference in symptomatic intracranial haemorrhage rates between our study and others using the same definition. The most widely accepted estimates of the true number needed to harm (for functional outcome at 3 months, following treatment within 3 hours) is about 30, as opposed to a number needed to benefit of around three.1
Our study does not suggest that thrombolysis increases mortality. Mortality cannot be compared between different populations, with different aetiology and severity.
We have demonstrated a large number of relative “protocol violations” according to 2007 guidelines, the most common of which was that the patient was older than 80 years, but there is robust evidence that thrombolysis is safe and effective in this cohort.2
The benefit of a therapy cannot be assessed by a tally of “positive” and “negative” trials. A recent meta-analysis of all tissue plasminogen activator trials (seven trials, 2199 patients),3 and the relevant Cochrane review,4 confirm benefit in appropriate patients treated with tissue plasminogen activator within 4.5 hours. Stroke thrombolysis is effective. We must overcome the barriers to administering it frequently, safely and rapidly.
References
- Saver JL. Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke. Arch Neurol 2004; 61: 1066-1070.<eMJA full text>
- Mishra NK, Ahmed N, Andersen G, et al. Thrombolysis in very elderly people: controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive. BMJ 2010; 341: c6046. 0_pgfId-2315998
- Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375: 1695-1703. 0_pgfId-2316006
- Wardlaw JM, Murray V, Berge E, Del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2009; (4): CD000213. 0_CBBJGCJJ
Motor Neuron Disease Mortality Trends in Australia From 1986 to 2023: A Population-Based Study
Carol M. Y. Lee, Rupendra N. Shrestha, Julian Gold, Mark Stevenson, Kelly L. Williams, Lyndal Henden, Sandrine K. K. Chan Moi Fat, Zoe Zussa, Amanda Wright, Martin Jude, Mark A. S. Laidlaw, Willem J. R. Fokkink, Dominic B. Rowe
Mild traumatic brain injury and concussion and persisting post‐concussion symptoms: new guidelines to support evidence‐based assessment and management in Australia and Aotearoa New Zealand
Karen M Barlow, Jennie L Ponsford, Alice Theodom, Gill Cowen, Gavin A Davis, Vicki Anderson, Franz E Babl, David Cole, Jennifer Cullen, Stuart R Dalziel, Melinda Fitzgerald, Howard Flavell, Caroline Yates, Rebecca Kimble, John H Olver, Rhonda Orr, Mark Ralfe, Michael Rose, Nick Rushworth, Julia Treleaven, Gary Browne, Nathan Delang, Sarah Harris, Gary Mitchell, Sean Tweedy
The prevalence of and variation in indicators of the quality and safety of long term aged care in Australia, 2019: a cross‐sectional population‐based study
Tesfahun C Eshetie, Gillian E Caughey, Catherine Lang, Olivia Ryan, Renuka Visvanathan, Craig Whitehead, Keith Evans, Janet K Sluggett, Jyoti Khadka, Carolyn Dawkins, Helena Williams, Miranda Starke, Sara Blunt, Anne Liddell, Megan Corlis, Anna Sheppeard, Penelope Lello, Marilyn Thien, Steven L Wesselingh, Maria C Inacio
Health and economic benefits of improving pre‐hospital identification of stroke in Australian women: a modelling study
Thomas Gadsden, Lei Si, Emily R Atkins, Cheryl Carcel, Xia Wang, Stephen Jan, Mark Woodward, Laura E Downey
Symptom burden, quality of life, and diagnostic journey of people with postural orthostatic tachycardia syndrome, Australia, 2021–24: a descriptive patient registry data study
Marie‐Claire Seeley, Gemma Wilson, Eric Ong, Amy Langdon, Jonathan Chieng, Danielle Bailey, Kristina Comacchio, Amanda Page, Dennis H Lau, Celine Gallagher
The intersection of rurality and dementia prevalence in Australia for Aboriginal and Torres Strait Islander and non‐Indigenous peoples
Antonia J Clarke, Marwan Ahmed, Judith M Katzenellenbogen, John Towney (Wiradjuri), Anna H Balabanski, Adrienne Withall (Dharawal Yuin), Kylie Radford, Amy Brodtmann