To the Editor.
—The optimistic Editorial1 on thrombolysis in stroke emphasizes the need for rapid intervention: "time is brain." Two recent trials of thrombolytics have suggested a benefit for patients treated within 3 hours of stroke onset, while no benefit was found in trials in which treatment was instituted after 3 hours.1-4 On the basis of the National Institute of Neurological Disorders and Stroke (NINDS) trial,4 the Food and Drug Administration has approved tissue-type plasminogen activator (t-PA) to be labeled for use in stroke if used within 3 hours.3 But does this 3-hour criterion, relying exclusively on patients' or family members' recollections, delineate a well-defined group of patients? Some patients ignore minor symptoms; others are acutely aware of new symptoms. In either case, how trustworthy is the sense of time under the emotional circumstances associated with an acute illness and being rushed to an emergency department?
Pincus MM. Thrombolysis for Stroke. JAMA. 1997;277(1):19. doi:10.1001/jama.1997.03540250027015