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This Week in JAMA
March 1, 2000

This Week in JAMA

JAMA. 2000;283(9):1103. doi:10.1001/jama.283.9.1103

In the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial, early thrombolytic therapy for acute ischemic stroke with intravenous tissue-type plasminogen activator (tPA) was associated with improved neurologic outcomes, but concern about increased risk of intracerebral hemorrhage (ICH) and the narrow therapeutic window of 3 hours from stroke onset have limited its use in general clinical practice. In this prospective study of 389 adults at 24 academic and 33 community medical centers treated with intravenous tPA, Albers and colleaguesArticle report that 30 days after treatment, mortality was 13%, and 35% of patients had a very favorable neurologic outcome (modified Rankin score, 0-1). The rate of symptomatic ICH within 3 days of treatment was 3.3%. Based on data from 29 Cleveland-area hospitals in the Cleveland Health Quality Choice project, Katzan and colleaguesArticle found that 70 (1.8%) of 3948 patients with ischemic stroke received intravenous tPA. Symptomatic ICH occurred in 11 (15.7%) of these patients, and in-hospital mortality was 15.7%, significantly higher than among patients who did not receive tPA (mortality rate, 5.1%). Deviation from national treatment guidelines was identified in 50% of patients who received tPA. In an editorial, MohrArticle discusses hypotheses about the etiology of ischemia and infarction in stroke and about the mechanism of action of thrombolytic therapy.