Abstract
To the Editor: The American Heart Association/American Stroke Association has expanded the time window for recombinant tissue plasminogen activator from 3 hours to 4.5 hours after stroke onset for many patients.1 The evidence2–7⇓⇓⇓⇓⇓ does not support a Class I recommendation (which will impact clinical care, quality measures, and medicolegal decisions), and we urge the American Heart Association/American Stroke Association to reconsider. The new recommendation is based on the European Cooperative Acute Stroke Study III (ECASS III), a high-quality trial in 821 patients.2 ECASS III found recombinant tissue plasminogen activator within 3 …
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