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January 26, 2005

Predictors of Lack of Improvement After Thrombolytic Stroke Therapy

JAMA. 2005;293(4):421. doi:10.1001/jama.293.4.421-a

To the Editor: In their study, Dr Saposnik and colleagues1 note that they followed the National Institute of Neurological Disorders and Stroke inclusion and exclusion criteria for the administration of a recombinant tissue plasminogen activator (alteplase) for acute stroke. However, 40 patients (18% of the study population) received alteplase after the accepted 3-hour window. The authors do not report the outcomes for this group of patients separately, but from the figure, approximately 50% of the cumulative total proportion of patients who failed to improve were treated after 3 hours. It would be important to know the ratio of risk to benefit for the administration of alteplase in this subgroup; as Dr Caplan described in his Editorial,2 there have been suggestions to extend the window for alteplase administration to as long as 4.5 hours.

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