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To the Editor: In their Editorial, Drs Mayberg and Furlan¹ indicate that the current evidence does not allow clinicians to decide whether tissue-type plasminogen activator (tPA) or ancrod is better for patients with acute ischemic stroke. A more basic question is whether either treatment is better than aspirin administered in the same time period. In these trials, patients randomized to the placebo group were prohibited from receiving any antithrombotic treatments for the first 24 hours in the study of tPA² or for the first 5 days in the study of ancrod.³ Do these protocols reflect the standard of care for such patients? Evidence now exists that aspirin may be beneficial in patients with acute ischemic stroke,^4-5 but information about its administration in the first 3 hours after the onset of symptoms is limited. The question of which treatment is best needs to be addressed because a treatment as simple, inexpensive, . . . [Full Text of this Article]

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