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To the Editor: I am concerned about the conclusions of the Editorial by Dr Caplan¹ that accompanied 2 studies on the use of thrombolytic therapy for acute stroke. The first article² reported a mortality rate of 10% among 1658 patients during the initial hospitalization, and 27.2% of patients had one or more serious complications. The second article³ reported that 111 (51.4%) of 216 patients who were treated with alteplase had a lack of improvement at 24 hours, 43 patients (20%) had died at 3 months, and 75 (44%) of 170 survivors had poor outcomes. The Editorial, although cautious, concluded that more patients should be given thrombolytic treatment, and that there is an urgent need to transport patients to stroke centers more quickly. There is no suggestion that a moratorium be placed on lytic therapy for acute stroke in community hospitals, which is a conclusion that could have been drawn . . . [Full Text of this Article]

Jerry J. Svoboda, MD
elixir17@aol.com
University of Rochester
Rochester, NY

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