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October 18, 2000

Outcomes of Ancrod in Acute Ischemic Stroke—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(15):1926-1927. doi:10.1001/jama.284.15.1921

In Reply: We appreciate Drs Orbach and Levine highlighting the worse outcomes of patients who received placebo with increasing time to treatment, as this is an observation that also struck us. We can verify their explanation that those who received placebo and entered our study later after stroke onset had worse stroke severity than those entering earlier. Specifically, the proportion of the placebo group with Scandinavian Stroke Scale scores of 30 to 39 (the group with the mildest deficits permitted in the study) decreased from 46.2% among those enrolled within 2 hours of stroke onset to 39.2% among those enrolled at 2 to 3 hours of onset, and further to 35.0% among those enrolled more than 3 hours after stroke onset. While the number of patients enrolled at less than 2 hours (n = 13) and more than 3 hours (n = 40) is relatively small, the impact of stroke severity on outcome is profound and, as suggested by Orbach and Levine, this probably explains the observed worsening outcome.