Letter by Dai et al regarding article, "Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the Third International Stroke Trial".

Abstract

Whiteley et al1 demonstrated their excellent work to investigate the relationship among intravenous recombinant tissue-type plasminogen activator (rtPA), risk of symptomatic intracranial hemorrhage (sICH), and 6-month prognosis based on series of risk prediction scores. They drew the conclusion that there is a clinically relevant net positive effect of rtPA in patients with acute stroke at a high predicted risk of sICH or poor functional outcome, as it said in the abstract. However, we discuss some issues from statistical aspects. In clinical practice, sICH remains the biggest concern when rtPA is administrated. sICH is associated with poor outcome after intravenous rtPA treatment, which is largely proved …