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April 3, 1996

Thrombolysis for Acute Stroke-Reply

Author Affiliations

University of Heidelberg Heidelberg, Germany
University of Helsinki Helsinki, Finland
University of Rome Rome, Italy for the ECASS Study Group

JAMA. 1996;275(13):984-985. doi:10.1001/jama.1996.03530370021013

In Reply.  —Dr Wood's assumption of increased incidence of brain edema following thrombolysis is not supported by ECASS data. Brain edema leading to herniation was found more frequently in the rt-PA—treated group, but this difference was not statistically significant. In the ITT analysis, the odds of dying from brain edema were 1.13 (confidence interval [CI], 0.82 to 1.56) at day 7 and 1.22 (CI, 0.93 to 1.59) at days 30 and 90.A shorter time to thrombolysis may be advantageous as indicated in the recently published National Institute of Neurological Disorders and Stroke (NINDS) trial.1 However, we believe it important to test whether a longer time window is feasible since it may lead to a therapeutic approach applicable to a larger number of stroke patients.Unfortunately, while most neuroprotective agents are effective in animal models of stroke, none of the substances has been shown to be effective in stroke