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Correspondence Alteplase for ischaemic stroke
Roger Shinton's Correspondence (Aug 23, p 659) called into question the evidence supporting the safe use of alteplase in patients with acute ischaemic stroke. Ian Hudson, of the Medicines and Healthcare Products Regulatory Agency (MHRA), responded to this Correspondence by convening an expert working group to review the benefits and risks of this drug. A review of reports of spontaneous adverse drug reactions (ADR) should inform this query, but a substantial level of under-reporting might restrict its use.
Source: LANCET - October 25, 2014 Category: Journals (General) Authors: Daniel Burrage Tags: Correspondence Source Type: research

Correspondence Questions about authorisation of alteplase for ischaemic stroke
Stroke thrombolysis can cause potentially fatal intracerebral haemorrhage, but advocates claim the potential reduction in disability justifies this risk. Alteplase was authorised following the National Institute of Neurological Disorders and Stroke (NINDS) trial. A 2004 review raised concerns over the trial data. Outcomes across the centres differed considerably. Bias could explain the observation that the plot of outcome (modified Rankin score 0–1) against number of patients recruited does not resemble the expected symmetrical funnel ().
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Roger Shinton Tags: Correspondence Source Type: research

Correspondence Alteplase for ischaemic stroke—responses
Roger Shinton's Correspondence contains numerous factual inaccuracies and statements that are not consistent with the text of the cited references, and do not in our opinion merit a reconsideration of the authorisation of alteplase in acute ischaemic stroke.
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Peter Sandercock, Richard Lindley, Joanna M Wardlaw, Gordon Murray, Will Whiteley, Geoff Cohen Tags: Correspondence Source Type: research

Wake-up Stroke and Onset-to-door Duration Delays: Potential Future Indications for Reperfusion Therapy.
Conclusion: The one- third proportion of wake-up stroke in this cohort and low prevalence of relative contraindications suggest this is a promising group for emerging thrombolysis indications. With the majority of patients presenting after 8 hours, widening of the therapeutic window with new potential reperfusion treatments would not appreciably increase treatment utilisation. This study reaffirms the urgent need for public education to improve stroke awareness in Singapore. PMID: 24557460 [PubMed - in process]
Source: Annals of the Academy of Medicine, Singapore - January 1, 2014 Category: Journals (General) Authors: Tan MSh, Ang ES, Ho SS, Ng SC, Talabucon L, Woon FP, De Silva DA Tags: Ann Acad Med Singapore Source Type: research

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