Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
In Reply: We appreciate Drs Orbach and Levine
highlighting the worse outcomes of patients who received placebo with increasing
time to treatment, as this is an observation that also struck us. We can verify
their explanation that those who received placebo and entered our study later
after stroke onset had worse stroke severity than those entering earlier.
Specifically, the proportion of the placebo group with Scandinavian Stroke
Scale scores of 30 to 39 (the group with the mildest deficits permitted in
the study) decreased from 46.2% among those enrolled within 2 hours of stroke
onset to 39.2% among those enrolled at 2 to 3 hours of onset, and further
to 35.0% among those enrolled more than 3 hours after stroke onset. While
the number of patients enrolled at less than 2 hours (n = 13) and more than
3 hours (n = 40) is relatively small, the impact of stroke severity on outcome
is profound and, as suggested by Orbach and Levine, this probably explains
the observed worsening outcome.
Sherman DG, Levy DE. Outcomes of Ancrod in Acute Ischemic Stroke—Reply. JAMA. 2000;284(15):1926-1927. doi:10.1001/jama.284.15.1921