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(Stroke. 2003;34:1112.)
© 2003 American Heart Association, Inc.

Original Contributions

Editorial Comment—tPA in Daily Clinical Practice

Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Lyon, France

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In 1995,¹ a 2-part randomized trial showed the efficacy of intravenous tissue plasminogen activator (tPA) when given within 3 hours of onset of symptoms of acute ischemic stroke. Postmarketing studies have demonstrated that intravenous recombinant tPA can be administered appropriately in a wide variety of hospitals setting. If treatment guidelines² are carefully followed, intravenous tPA for acute ischemic stroke is feasible and shows safety and efficacy comparable to the results from the study by the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.^3–6 However, although the persuasive results of that study have launched some enthusiasm, safety and efficacy concerns about the use of thrombolysis for ischemic stroke prevail among many neurologists because of the risk of hemorrhage and the small proportion of suitable patients. Further concerns are nourished by a report from "the real world" in which the translation of study results into daily clinical practice seemed to be less easy and more harmful than expected.^6,7

In European countries, there is little information about early outcomes after intravenous application of tPA for stroke patients treated in community-based settings. In this issue of Stroke, Heuschmann et al report the largest experience from the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall Register [ADSR]). ADSR is a network of regional stroke registers that combines data from 104 academic and community hospitals throughout Germany and represents 5% of all acute stroke hospitals in Germany. Therefore, the description reflects the special situation of the German healthcare system. The main result . . . [Full Text of this Article]