Thrombolytic therapy for stroke signals a breakthrough, through clots and nihilistic attitudes. Although a systematic approach to stroke care as exemplified by stroke units has been shown to improve outcomes,1 recombinant tissue-type plasminogen activator (rt-PA) is the first drug to make a demonstrable difference to stroke.
Brott provides the facts, and Riggs offers the context. Under the strict conditions of the National Institutes of Health Study, little doubt exists that rt-PA therapy offers a benefit, but at the risk of death from rt-PA in a ratio of 4:1.
This choice should be offered to as many patients as possible, provided the following are available:
• Medical expertise in the diagnosis and management of acute stroke.
• High-quality imaging and interpretation.
• Facilities and expertise to monitor blood pressure, diagnose intracranial hemorrhage, and manage the consequences.
A center that fulfills these criteria would also be able to participate in clinical