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To the Editor.—In his Letter to the Editor, Dr Alexander¹ asserts that recombinant tissue-type plasminogen activator (rt-PA) given for acute ischemic stroke "may not increase the risk of hemorrhagic transformation." Alexander refers to the study by Larrue et al,² which defined parenchymal hemorrhage to be the clinically significant type of hemorrhagic transformation, and showed parenchymal hemorrhage to occur 3 times more frequently in patients treated with rt-PA compared with those treated with placebo. This risk of hemorrhage can be compared with the results of the National Institutes of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study,³ which showed that patients treated with rt-PA were 11 times more likely to develop symptomatic nonfatal hemorrhage and were 9 times more likely to die of intracranial hemorrhage than were patients treated with placebo. These data emphasize the importance for a physician never to underestimate the risks of intravenous rt-PA administered during acute . . . [Full Text of this Article]

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