Thrombolysis in acute stroke
- rtPA is indeed useful in acute Ischemic stroke
- Elderly need not be excluded (Even > 80y)
- Time window : It definitely works up to 4.5 hours and vary likely to be effective up t0 6 hours.
We are gradually widening the time window , which was 3 hours a decade ago .It may soon catch up with STEMI window of 12 hours ! ( Mitochondrially myocytes are not vastly different from cerebro-cytes ! )
So , the current role of of thrombolyis for stroke is best answered by the editorial accomplishing this article !
“The role of stroke and emergency physicians is now not to identify patients who will be given rt-PA, but to identify the few who will not.”
Reference : A Lancet Break through
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960738-7/fulltext
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2960768-5/fulltext
Coming soon
- By the way , rTPA is prohibitively costly for common world citizens . Please tell us about streptokinase in stroke ? Does the poor cousin match the rich ?
- Do we have primary cerebral angioplasty ?
Please read the comment form Dr Anthony Andrew Bell it is a must read !
Dr.S.Venkatesan MD 
I am a GP In New Zealand would you comment on the following which comes from http://smartem.org/content/delusions-benefit-international-stroke-trial?destination=node%2F34
(With advances in scientific literacy it has been years since I have seen a top journal allow authors to proclaim a conclusion in direct conflict with their own primary study results. And yet the authors blithely conclude that thrombolytics “improved functional outcome.” Worse, an accompanying editorial trumpets that “the role of stroke and emergency physicians is now not to identify patients who will be given rt-PA, but to identify the few who will not.” Welcome to Wonderland.
These statements feel not just forced, but frankly delusional. Has neuro gone psycho? The results of IST-3 indicate, at best, a profound disappointment (even the hallucinated benefit would be tinier than any previously claimed) and at worst the beginning of the end for thrombolytics in stroke. In either case, reality may be tough to handle, but it is not a matter of debate, or interpretation, or perception. The primary outcome failed. We have a phrase for that: no benefit.)
Dear Dr Anthony Andrew Bell
Thank you for the excellent Input on the issue .
Truth should triumph at any cost.
I know as a cardiologist how the research data is cooked up and selectively misinterpreted to reach a desired conclusion.
I just failed to realise it is same bad old story every where .
I wonder , after reading your comment , whether I should change the title to dangerous new data from IST 3 !
Thanks again
Venkatesan