Pittman raises legitimate concerns regarding the use of tissue-type plasminogen activator in acute ischemic stroke, while subtly supporting its use. The issue of informed consent, compounded by very significant time constraints, is certainly problematic. Nonetheless, the NINDS rt-PA trial1 data indicate that when patients and their family members had to make rapid decisions, they did so affirmatively; only 3.8% of patients eligible to receive medication were unwilling or unable to consent. Thus, patients, or their relatives, when faced with the prospect of a debilitating stroke, strongly favored a medication that held the promise of neurologic improvement—despite its risks, that it was experimental at that time, and with only a 50-50 chance of receiving active drug.
Horowitz SH. Tissue-Type Plasminogen Activator—Reply. Arch Neurol. 1998;55(10):1077-1078. doi: