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December 1996

Thrombolysis in Acute Stroke

Author Affiliations

London, Ontario

Arch Neurol. 1996;53(12):1308. doi:10.1001/archneur.1996.00550120120027

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

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