Acute stroke treatment; who is going to bleed?

Abstract

The value of acute treatment for ischaemic stroke was initially demonstrated in 1995 by the National Institute of Neurological Disorders rt-PA Stroke Study Group (NINDS). 1 NINDSTissue plasminogen activator for acute ischemic stroke: the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995; 333: 1581-1587 Crossref PubMed Scopus (9943) Google Scholar This indicated that patients treated by intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) within 3 h of stroke onset are more likely to have minimal or no disability at 3 months. Sustained benefits at 1 year and cost-effectiveness have been shown in subsequent studies. 2 Kwiatkowski T.G. Libman R.B. Frankel M. et al. Effects of tissue plasminogen activator for acute ischemic stroke at 1 year: National Institute of Neurological Disorders Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group. N Engl J Med. 1999; 340: 1781-1787 Crossref PubMed Scopus (503) Google Scholar , 3 Fagan S.C. Morgenstern L.B. Petitta A. et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke: NINDS rt-PA Stroke Study Group. Neurology. 1998; 50: 883-890 Crossref PubMed Scopus (338) Google Scholar The neuroimaging diagnostic technique used by most acute stroke treatment programmes is still computed tomography (CT). Indeed the 2005 update statement from the stroke council of the American Heart Association/American Stroke Association states that there are no data at present to show that magnetic resonance imaging (MRI) is superior to CT for selecting patients who could be treated with intravenous rt-PA. 4 Adams H. Adams R. Del Zoppo G. Goldstein L.B. Guidelines for the early management of patients with ischemic stroke. 2005 guidelines update. A scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke. 2005; 36: 916-921 Crossref PubMed Scopus (381) Google Scholar