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(Stroke. 1998;29:1476-1477.)
© 1998 American Heart Association, Inc.

Letters to the Editor

Ischemic Strokes Arriving Too Late for tPA Are an Ideal and Ethical Control Group for Continuing Studies of tPA Efficacy

Lewis Robinson, MD

Diplomat of the American Board of Psychiatry and Neurology, Marcellus, NY

To the Editor:

The report of Chiu et al¹ showed that a single university hospital and 2 community hospitals could achieve results comparable to those of the recent NINDS rt-PA Study. Thirty patients were treated from a possible 267 patients appearing in the 3 emergency rooms.

Thirty-seven percent of the remaining 237 patients were rejected because the time limit for treatment was exceeded. This group accounts for nearly 3 times the number of patients actually treated. No mention in the paper was made of how these people fared or whether there was any attempt at follow-up. An age- and sex-matched control for those who were selected for treatment ought to be buried in this group of nearly 90 patients; the only distinguishing variable would be the time of onset.

It would be of great interest to know whether this control group had a worse outcome than the people receiving therapy. The report's authors already may have the data or could obtain it. For most neurologists in practice over 10 years, their first experience with thrombolytic therapy was being called to the ICU after intracerebral hemorrhage when the therapy had been used for myocardial infarction. They next read the 4 negative studies on thrombolytic therapy before the NINDS Study. Their subsequent experience is likely to have been intense pressure from the media and academic powers-that-be to ignore the first 4 studies and to apply the therapy, along with pressure from hospitals in competition with others to use the latest (if not . . . [Full Text of this Article]

David Chiu, MD

Department of Neurology, Baylor College of Medicine, The Methodist Hospital, Houston, Texas