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April 22/29, 1998

More on Thrombolytic Therapy for Acute Stroke

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(16):1262. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-16-jac80007

To the Editor.—In his Letter to the Editor, Dr Alexander1 asserts that recombinant tissue-type plasminogen activator (rt-PA) given for acute ischemic stroke "may not increase the risk of hemorrhagic transformation." Alexander refers to the study by Larrue et al,2 which defined parenchymal hemorrhage to be the clinically significant type of hemorrhagic transformation, and showed parenchymal hemorrhage to occur 3 times more frequently in patients treated with rt-PA compared with those treated with placebo. This risk of hemorrhage can be compared with the results of the National Institutes of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study,3 which showed that patients treated with rt-PA were 11 times more likely to develop symptomatic nonfatal hemorrhage and were 9 times more likely to die of intracranial hemorrhage than were patients treated with placebo. These data emphasize the importance for a physician never to underestimate the risks of intravenous rt-PA administered during acute stroke.