EMA April 2013

From Andrew Gosbell & Tony BrownIssue 2 (Vol. 25) of Emergency Medicine Australasia published online on 6 February 2013Stroke thrombolysis: editorial perspectives and letters  (#FOAMed)Debate continues on the use of tPA in acute ischaemic stroke (AIS). Editorial by Klening et al, address previous (October 2012) criticisms in editorials by Hoffmann & Cooper and Fatovich, arguing that, despite its acknowledged flaws, the Third International Stroke Trial (IST-3)  strengthens the evidence for the benefits of thrombolysis within up to 6 hours of AIS and also shows a corresponding benefit for elderly patients. They call on emergency physicians to collaborate on shortening onset to thrombolysis delivery time, and examining further improvements to this therapy. Bladin et al in their letter, also dispute these previous criticisms contending that the IST-3 methodology, inclusion criteria and analysis were appropriate and recognised the strengths of the trial, with updated systematic reviews and meta-analysis supporting IST-3 and confirming the benefit of early treatment with tPA in AIS. In response a letter from Hoffmann & Cooper, reiterates that the primary outcome measure for IST-3 strongly demonstrated not only an absence of benefit, but probable harm. Fatovich responds, by questioning the reliance on meta-analyses to support stroke thrombolysis, particularly as the integrity of one of the only two positive stroke lysis studies in this evidence base ...
Source: Life in the Fast Lane - Category: Emergency Medicine Doctors Authors: Tags: Education eLearning EMA Emergency Medicine Featured Journal April emergency medicine australasia Source Type: blogs