Looks like there's no good evidence that the treatment is beneficial, yet it's been accepted as "standard of care." Will it be included in the 2nd edition of Ending Medical Reversal . . . ?
I remember that IST3 was widely praised for proving IV thrombolysis for Stroke is brain saving , even though a quick glance at the results indicated the opposite. That was gobsmacking.
The NINDS trials were heavily criticised at the time, but the ED “deniers” failed to get their message across. They were largely castigated for that. I remember Jerome Hoffman, ACEP, Buchan, Donnan, Hachinski, Hankey, Joanna Wardlaw...
Thank you for this analysis. Many ED docs recognize that TNK isn’t great, but we have guidelines we have to adhere to… Long ago I told my husband that if I can’t consent for TNK (because my Rankin score is so bad) then I shouldn’t get it. The worse the stroke, it seems, the less likely TNK is to help.
Looks like there's no good evidence that the treatment is beneficial, yet it's been accepted as "standard of care." Will it be included in the 2nd edition of Ending Medical Reversal . . . ?
I remember that IST3 was widely praised for proving IV thrombolysis for Stroke is brain saving , even though a quick glance at the results indicated the opposite. That was gobsmacking.
The NINDS trials were heavily criticised at the time, but the ED “deniers” failed to get their message across. They were largely castigated for that. I remember Jerome Hoffman, ACEP, Buchan, Donnan, Hachinski, Hankey, Joanna Wardlaw...
Also :
Ryan Radecki (look up his blog https://www.emlitofnote.com/?s=thrombolysis )
And a recent (2020) blog note by Salim Rezaie that recaps there are zero positive trials for thrombolysis in acute ischemic stroke:
https://rebelem.com/thrombolysis-in-acute-ischemic-stroke-now-we-have-no-positive-rcts/
Thank you for this analysis. Many ED docs recognize that TNK isn’t great, but we have guidelines we have to adhere to… Long ago I told my husband that if I can’t consent for TNK (because my Rankin score is so bad) then I shouldn’t get it. The worse the stroke, it seems, the less likely TNK is to help.
Well said - I hope you don’t cop a backlash for giving an assessment on less than robust data.