Two recent randomized, double-blind, placebo-controlled studies1,2 demonstrated a statistically significant improved neurological outcome at 3 months when patients were treated within 3 to 6 hours of the onset of acute ischemic stroke with recombinant tissue-type plasminogen activator (rt-PA). Do these 2 studies, however, suggest that rt-PA should now be used to treat acute ischemic stroke? To rationally address this question, an accurate assessment of the benefits and hazards of rt-PA must be identified.
THE PSYCHOLOGY OF CHOICE
If decisions regarding therapeutic options are rational, one might expect them to be consistent. However, physicians and patients make therapeutic decisions based on the outcomes they prefer. Physicians and patients will choose therapies presented from the perspective of benefit and survival and reject the very same therapies when presented from the perspective of hazard and mortality.3,4 The psychology of choice is heavily dependent on the framing of decisions. A classic example
Riggs JE. Tissue-Type Plasminogen Activator Should Not Be Used in Acute Ischemic Stroke. Arch Neurol. 1996;53(12):1306–1308. doi:10.1001/archneur.1996.00550120118026
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