Volume 199 - Issue 3
Stroke care in Australia: why is it still the poor cousin of health care?
Author: Stephen P J Macdonald
Med J Aust 2013; 199 (3): 166. || doi: 10.5694/mja13.10419
Published online: 5 August 2013
Published online: 5 August 2013
To the Editor: In their editorial on stroke care in Australia, Hoffman and Lindley state “only 7% of ischaemic stroke patients received thrombolysis treatment, yet for every 100 patients who receive it, there are up to 10 extra independent survivors”,1 citing the most recent meta-analysis.2 This research also found a significant increase in the risk of early death with thrombolysis, mostly from intracranial haemorrhage. For the individual ...
To the Editor: In their editorial on stroke care in Australia, Hoffman and Lindley state “only 7% of ischaemic stroke patients received thrombolysis treatment, yet for every 100 patients who receive it, there are up to 10 extra independent survivors”,1 citing the most recent meta-analysis.2 This research also found a significant increase in the risk of early death with thrombolysis, mostly from intracranial haemorrhage. For the individual patient, predicting final neurological outcome is difficult in the early hours after the onset of stroke. Patients considering thrombolysis treatment must weigh up an increased risk of early death against possible improvement in final function if they survive. In addition, any benefits from thrombolysis appear modest at best.
The third International Stroke Trial (IST-3), the most recently published and largest randomised trial of thrombolysis in stroke, in fact showed no improvement in the proportion of patients alive and independent at 6 months.3 Hoffman and Lindley describe a number of evidence–practice gaps, including early assessment for transient ischaemic attack and access to multidisciplinary stroke unit care. Patients and the community may be better served by directing resources to such areas where stronger evidence of overall benefit exists.
Competing interests
No relevant disclosures.
References
- Hoffman TC, Lindley RI. Stroke care in Australia: why is it still the poor cousin of health care? Med J Aust 2013; 198: 246-247. 0_BABEIJII
- Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; 379: 2364-2372. 0_i1142858
- Sandercock P, Wardlaw JM, Lindley RI, et al; IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012; 379: 2352-2363. 0_i1142862