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September 25, 1996, Vol 276, No. 12 >
ARTICLE | September 25, 1996

Thrombolysis in Stroke: Title and subTitle BreakBetween the Promise and the Peril FREE

Vladimir Hachinski, MD, DSc(Med)
[+] Author Affiliations

Reprints: Vladimir Hachinski, MD, DSc(Med), Department of Clinical Neurological Sciences, University of Western Ontario, 339 Windermere Rd, London, Ontario, Canada N6A 5A5.


JAMA. 1996;276(12):995-996. doi:10.1001/jama.1996.03540120073038
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Article
References

Thrombolysis in stroke represents a break, through clots and nihilism.1 Although thrombolysis can only be recommended for a minority of patients and under the strictest circumstances, it demonstrates dramatically that stroke can be treated. While the Australian Streptokinase (ASK) Trial2 reported in this issue of THE JOURNAL was stopped early, it adds to the growing evidence that prompt intervention makes a difference in stroke. Unlike a cardiac arrest, in which brain viability is counted in minutes, early ischemic stroke harbors a dynamic mixture of salvageable tissue offering therapeutic windows lasting for hours.3 The earlier the intervention, the better the prognosis; time is brain.4 Similarly, the sooner thrombolytics are given, the better the chance for arterial recanalization and the lower the risk of complications.5 This was a prior hypothesis and a finding of the ASK Trial, which suggested a beneficial effect in patients treated with streptokinase within

REFERENCES

1 +
Hachinski V. Thrombolysis in acute stroke. Arch Neurol. In press.
2 +
Donnan GA, Davis SM, Chambers BR, et al.  Streptokinase for acute ischemic stroke with relationship to time of administration . JAMA . 1996;;276:961-966.
3 +
Baron JC, von Kummer R, del Zoppo GJ.  Treatment of acute ischemic stroke: challenging the concept of a rigid and universal time window . Stroke . 1995;;26:2219-2221.
4 +
Gomez CR.  Time is brain! J Stroke Cerebrovasc Dis . 1993;;3:1-2.
5 +
del Zoppo GJ. Thrombolytic therapy in stroke. In: Agnelli G, ed. Thrombolysis Yearbook. Amsterdam, the Netherlands: Excerpta Medica. In press.
6 +
Hacke W, Kaste M, Fieschi C, et al.  Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS) . JAMA . 1995;;274:1017-1025.
7 +
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.  Tissue plasminogen activator for acute ischemic stroke . N Engl J Med . 1995;;333:1581-1587.
8 +
Fibrinolytic Therapy Trialists' (FTT) Collaborative Group.  Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients . Lancet . 1994;;343:311-322.
9 +
The Multicentre Acute Stroke Trial—Italy (MAST-I) Group.  Randomised controlled trial of streptokinase, aspirin,and combination of both in treatment of acute ischaemic stroke . Lancet . 1995;;346:1509-1514.
10 +
The Multicenter Acute Stroke Trial—Europe Study Group.  Thrombolytic therapy with streptokinase in acute ischemic stroke . N Engl J Med . 1996;;335:145-150.
11 +
Riggs JE. Tissue plasminogen activator should not be used in acute ischemic stroke. Arch Neurol. In press.
12 +
Norris JW, Hachinski VC.  Misdiagnosis of stroke . Lancet . 1982;;1:328-331.
13 +
Libman RB, Wirkowski E, Alvir J, Rao TH.  Conditions that mimic stroke in the emergency department . Arch Neurol . 1995;;52:1119-1122.
14 +
Gavrilescu T, Kase CS.  Clinical stroke syndromes: clinical-anatomical correlations . Cerebrovasc Brain Metab Rev . 1995;;7:218-239.
15 +
Hachinski V. Quoted by: Petit C.  Victims of stroke much more likely to live through it . San Francisco Chronicle . (February 22) , 1991;:A22.
16 +
Hachinski V. Brain Attack. In press.
17 +
Futrell N, Millikan CH.  Stroke is an emergency . Dis Mon . 1996;;42:199-264.
18 +
Kothari R, Barsan W, Brott T, Broderick J, Ashbrock S.  Frequency and accuracy of prehospital diagnosis of acute stroke . Stroke . 1995;;26:937-941.
19 +
Langhorne P, Williams BO, Gilchrist W, Howie K.  Do stroke units save lives? Lancet . 1993;;342:395-398.
20 +
Jørgensen HS, Nakayama H, Raaschou HO, Larsen K, Hübbe P, Olsen TS.  The effect of a stoke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost . Stroke . 1995;;26:1178-1182.
21 +
Powers WJ.  Acute hypertension after stroke: the scientific basis for treatment decisions . Neurology . 1993;;43:461-467.
22 +
Reith J, Jørgensen HS, Pederson PM, et al.  Body temperature in acute ischaemic stroke: relation to stroke severity, infarct size, mortality, and outcome . Lancet . 1996;;347:422-425.
23 +
Modan B, Wagner DK.  Some epidemiological aspects of stroke: mortality/ morbidity trends, age, sex, race, socioeconomic status . Stroke . 1992;;23:1230-1236.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Hachinski V. Thrombolysis in acute stroke. Arch Neurol. In press.
2 +
Donnan GA, Davis SM, Chambers BR, et al.  Streptokinase for acute ischemic stroke with relationship to time of administration . JAMA . 1996;;276:961-966.
3 +
Baron JC, von Kummer R, del Zoppo GJ.  Treatment of acute ischemic stroke: challenging the concept of a rigid and universal time window . Stroke . 1995;;26:2219-2221.
4 +
Gomez CR.  Time is brain! J Stroke Cerebrovasc Dis . 1993;;3:1-2.
5 +
del Zoppo GJ. Thrombolytic therapy in stroke. In: Agnelli G, ed. Thrombolysis Yearbook. Amsterdam, the Netherlands: Excerpta Medica. In press.
6 +
Hacke W, Kaste M, Fieschi C, et al.  Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS) . JAMA . 1995;;274:1017-1025.
7 +
The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group.  Tissue plasminogen activator for acute ischemic stroke . N Engl J Med . 1995;;333:1581-1587.
8 +
Fibrinolytic Therapy Trialists' (FTT) Collaborative Group.  Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients . Lancet . 1994;;343:311-322.
9 +
The Multicentre Acute Stroke Trial—Italy (MAST-I) Group.  Randomised controlled trial of streptokinase, aspirin,and combination of both in treatment of acute ischaemic stroke . Lancet . 1995;;346:1509-1514.
10 +
The Multicenter Acute Stroke Trial—Europe Study Group.  Thrombolytic therapy with streptokinase in acute ischemic stroke . N Engl J Med . 1996;;335:145-150.
11 +
Riggs JE. Tissue plasminogen activator should not be used in acute ischemic stroke. Arch Neurol. In press.
12 +
Norris JW, Hachinski VC.  Misdiagnosis of stroke . Lancet . 1982;;1:328-331.
13 +
Libman RB, Wirkowski E, Alvir J, Rao TH.  Conditions that mimic stroke in the emergency department . Arch Neurol . 1995;;52:1119-1122.
14 +
Gavrilescu T, Kase CS.  Clinical stroke syndromes: clinical-anatomical correlations . Cerebrovasc Brain Metab Rev . 1995;;7:218-239.
15 +
Hachinski V. Quoted by: Petit C.  Victims of stroke much more likely to live through it . San Francisco Chronicle . (February 22) , 1991;:A22.
16 +
Hachinski V. Brain Attack. In press.
17 +
Futrell N, Millikan CH.  Stroke is an emergency . Dis Mon . 1996;;42:199-264.
18 +
Kothari R, Barsan W, Brott T, Broderick J, Ashbrock S.  Frequency and accuracy of prehospital diagnosis of acute stroke . Stroke . 1995;;26:937-941.
19 +
Langhorne P, Williams BO, Gilchrist W, Howie K.  Do stroke units save lives? Lancet . 1993;;342:395-398.
20 +
Jørgensen HS, Nakayama H, Raaschou HO, Larsen K, Hübbe P, Olsen TS.  The effect of a stoke unit: reductions in mortality, discharge rate to nursing home, length of hospital stay, and cost . Stroke . 1995;;26:1178-1182.
21 +
Powers WJ.  Acute hypertension after stroke: the scientific basis for treatment decisions . Neurology . 1993;;43:461-467.
22 +
Reith J, Jørgensen HS, Pederson PM, et al.  Body temperature in acute ischaemic stroke: relation to stroke severity, infarct size, mortality, and outcome . Lancet . 1996;;347:422-425.
23 +
Modan B, Wagner DK.  Some epidemiological aspects of stroke: mortality/ morbidity trends, age, sex, race, socioeconomic status . Stroke . 1992;;23:1230-1236.

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