—Dr Pincus raises some important points concerning thrombolytic therapy in acute ischemic stroke. The first of these is the precision with which patients can be certain of the time of onset. The current indications for the use of t-PA in the United States are based on the NINDS trial and stipulate administration of the drug within 3 hours of onset. Clearly, it will not always be possible for patients to be absolutely certain of the time of ictus, although our experience in the ASK trial1 would suggest that the majority of people are reasonably certain within this relatively short time frame. If uncertainty does exist, then it would be unreasonable to administer thrombolytic therapy, particularly if the time after stroke onset was approaching 3 hours.The issue concerning variability of infarct size and location influencing disability scores, such as the Barthel Index, is an interesting one. To our knowledge,
Donnan GA, Davis SM, Chambers BR, et al. Thrombolysis for Stroke-Reply. JAMA. 1997;277(1):19–20. doi:10.1001/jama.1997.03540250027017
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