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Comment & Response
October 2014

Risk Index and Thrombolytic Treatment in Acute Ischemic Stroke

Author Affiliations
  • 1Chelsea Community Hospital, Chelsea, Michigan
  • 2Emergency Physicians Medical Group PC, Ann Arbor, Michigan
JAMA Neurol. 2014;71(10):1326. doi:10.1001/jamaneurol.2014.2294

To the Editor In the article by Ovbiagele et al1 published in JAMA Neurology—which tested the hypothesis that patients with stroke with a positive SPAN-100 index (the sum of a patient’s age plus National Institutes of Health Stroke Scale of 100 or greater) selected from the Virtual International Stroke Trials Archive (VISTA) database might benefit from thrombolysis—the authors concluded that such SPAN-100–positive patients “should probably not be denied thrombolysis treatment on the basis of such a profile alone.” Likewise they conclude that “the answer to the question posed about what to do regarding very elderly patients with very severe strokes…seems to be to treat them with intravenous thrombolysis….” They concluded this from finding that the SPAN-100 patients in their selection from the VISTA database treated with thrombolysis did better than those who did not receive that treatment (adjusted odds ratio, 0.46 [95% CI, 0.29-0.71]) The many limitations noted by the authors of querying the artificially created VISTA database are delineated and are very significant, yet do not seem to prevent the authors from making such treatment recommendations. This is also counter to the VISTA database founders stating that “[t]he VISTA database does not sanction reanalysis of any trial data that will test treatment effects….”2

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