There is a broad range of responses to any new treatment, especially when overall positive results are accompanied by substantial risks. What is more surprising to me than the apathy that Horowitz1 deplores is the seemingly unbridled enthusiasm that treatment with tissue-type plasminogen activator has elicited in others at the opposite end of the spectrum.
My assessment of the available information about the National Institute of Neurological Diseases and Stroke (NINDS rt-PA) trial2 is that tissue-type plasminogen activator indeed represents a potentially useful option for the management of acute stroke. At the same time, even Horowitz acknowledges that the risks of treatment are substantial: bleeding after the use of tissue-type plasminogen activator produces a horrendous outcome. Therefore, there must be adequate informed consent with the data presented as objectively as possible. The patient and/or family has to be willing to accept the risks as well as the potential benefits associated with tissue-type plasminogen activator .
Pittman GL. Tissue-Type Plasminogen Activator. Arch Neurol. 1998;55(10):1077-1078. doi: