Do you know of a robust modern evaluation of the evidence for thrombolysis for stroke in general? There was so much debate about whether thrombolysis is effective in general for stroke, and it feels to me like those concerns have been just passed over without ever being addressed. It's not clear to me if I hear less and less about that because the debate has been resolved in the favor of thrombolysis, or if the evidence is still as shaky that thrombolytics are effective for stroke at all, but there's no further appetite for debate as thrombolytics are required, correct or not. Would appreciate your thoughts.
"Robust modern evaluation" of the evidence for stroke will be non-existent. They haven't generated new data for the main indication in nearly 15+ years, now, since ECASS III and IST-3, and the book was basically closed on it by the individual patient meta-analysis subsequently published.
The only new data being generated is indication creep into minor and non-disabling stroke – and those failures ought to prompt further questions narrowing treatment, but there's no appetite for a new trial challenging already accepted practice.
I have mixed thoughts on thrombolysis, and generally speaking, the benefits likely outweigh the harms. The EVT trials show 1) salvageable tissue + 2) reperfusion = some recovery. I'm sure thrombolysis helps some stroke patients who have that, but there are many who don't have 1) and don't get 2) and we don't really care to investigate 1) unless it's an extended time window. We could do so much better to spare folks the risks of thrombolysis and diagnostic inertia/anchoring in early time windows.
I really wish there was at least a reliable summary of this issue, the concerns about the evidence, and realistic benefits rather than a constant push to lyse broader and broader populations further and further out in time.
There never was any robust data surrounding thrombolytics for stroke. Thrombolytics were forced down everybodies throat because of feeling the need to do something about a devastating disease; It continues to propagate because of a tremendous bureaucracy (accrediting agencies, hospital funding/stroke centers, employees and EMS systems, etc) needing its continuation to exist..... None of the studies showing benefit were EVER beyond criticism or analysis and many of the studies showing harm (and the significant numbers they would have added to the pool of treated patients if allowed to continue) have been forgotten
Do you know of a robust modern evaluation of the evidence for thrombolysis for stroke in general? There was so much debate about whether thrombolysis is effective in general for stroke, and it feels to me like those concerns have been just passed over without ever being addressed. It's not clear to me if I hear less and less about that because the debate has been resolved in the favor of thrombolysis, or if the evidence is still as shaky that thrombolytics are effective for stroke at all, but there's no further appetite for debate as thrombolytics are required, correct or not. Would appreciate your thoughts.
"Robust modern evaluation" of the evidence for stroke will be non-existent. They haven't generated new data for the main indication in nearly 15+ years, now, since ECASS III and IST-3, and the book was basically closed on it by the individual patient meta-analysis subsequently published.
The only new data being generated is indication creep into minor and non-disabling stroke – and those failures ought to prompt further questions narrowing treatment, but there's no appetite for a new trial challenging already accepted practice.
I have mixed thoughts on thrombolysis, and generally speaking, the benefits likely outweigh the harms. The EVT trials show 1) salvageable tissue + 2) reperfusion = some recovery. I'm sure thrombolysis helps some stroke patients who have that, but there are many who don't have 1) and don't get 2) and we don't really care to investigate 1) unless it's an extended time window. We could do so much better to spare folks the risks of thrombolysis and diagnostic inertia/anchoring in early time windows.
Very helpful, thank you.
I really wish there was at least a reliable summary of this issue, the concerns about the evidence, and realistic benefits rather than a constant push to lyse broader and broader populations further and further out in time.
There never was any robust data surrounding thrombolytics for stroke. Thrombolytics were forced down everybodies throat because of feeling the need to do something about a devastating disease; It continues to propagate because of a tremendous bureaucracy (accrediting agencies, hospital funding/stroke centers, employees and EMS systems, etc) needing its continuation to exist..... None of the studies showing benefit were EVER beyond criticism or analysis and many of the studies showing harm (and the significant numbers they would have added to the pool of treated patients if allowed to continue) have been forgotten