Citations 0
Letters to the Editor
October 1998

Tissue-Type Plasminogen Activator—Reply

Author Affiliations

Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Neurol. 1998;55(10):1077-1078. doi:

In reply

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.

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