Intensive Care Network Podcasts

Stroke thrombolysis - why are we still arguing? Summary by Lachlan Donaldson The debate regarding the efficacy of thrombolysis grumbles on… How is it that two different groups (i.e. mostly ED doctors and neurologists) can look at the same set of trials and come to fundamentally different conclusions? To examine this, these authors have attempted to perform an unbiased meta-analysis and systematic appraisal of the evidence supporting the use of thrombolysis in ischaemic stroke (paper available here). Consistent with other meta-analyses, the authors found a moderately increased probability of good functional outcome (OR 1.14) alongside a markedly increased risk of ICH (OR 4.28). However, as discussed, this debate is likely to be driven by the quality of the trials that populate this meta-analysis. For instance, of the 16 studies that nominated a specific primary outcome, only 2 studies reported a significant treatment effect in favour of thrombolysis as their primary outcome- the NINDS trial and ECASS III.