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Thrombolytic Therapy for Acute Ischemic Stroke: The CAEP Position Statement: another perspective

Published online by Cambridge University Press:  21 May 2015

Michael D. Hill ,
Gordon J. Gubitz ,
Stephen J. Phillips  and
Alastair M. Buchan
Michael D. Hill*
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alta
Gordon J. Gubitz
Affiliation:
Division of Neurology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Stephen J. Phillips
Affiliation:
Division of Neurology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Alastair M. Buchan
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alta
*
Department of Clinical Neurosciences, University of Calgary, Rm. MRG005, Foothills Medical Centre, 1403 29th St. NW, Calgary AB T2N 2T9; [email protected]

Extract

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The cautiously-worded Position Statement recently issued by the Canadian Association of Emergency Physicians (see Appendix 1) regarding the use of intravenous recombinant tissue-plasminogen activator (tPA, alteplase) for acute ischemic stroke underscores the reality that many physicians in Canada have been reluctant to embrace this therapy. Much of the caution expressed in the CAEP document is related to 2 major areas of concern: evidence of efficacy (i.e., did tPA really “prove” itself in randomized trials?) and effectiveness (i.e., are the trial results generalizable to everyday practice?). While we support the development of documents that help to clarify controversial treatments, and agree with much of what is presented in the CAEP Position Statement, we offer the following comments.

Type
Controversies • Controverses
Information
Canadian Journal of Emergency Medicine , Volume 3 , Issue 3 , July 2001 , pp. 180 - 182
Copyright
Copyright © Canadian Association of Emergency Physicians 2001

References

1.CAEP Committee on Thrombolytic Therapy for Acute Ischemic Stroke. Thrombolytic therapy for acute ischemic stroke [position statement]. CJEM 2001;3(1):8–12.CrossRefGoogle Scholar
2.Wardlaw, JM, del Zoppo, G, Yamaguchi, T.Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2000;(2): CD000213. In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.Google Scholar
3.NASCET Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–53.CrossRefGoogle Scholar
4.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;343:311–22.Google Scholar
5.CASES (Canadian Activase for Stroke Effectiveness Study), a Collaboration between the Canadian Stroke Consortium, Hoffman–La Roche Limited, and the Heart and Stroke Foundation of Canada. Available: www.strokeconsortium.ca/CASES (accessed 2001 Apr 12).Google Scholar
6.Albers, GW, Bates, VE, Clark, WM, Bell, R, Verro, P, Hamilton, SA.Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA 2000;283:1145–50.Google Scholar
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(24):1581–7.Google Scholar
8.Fletcher, D, Hill, MD, Buchan, AM, for the CASES investigators. The Canadian Activase for Stroke Effectiveness Study (CASES) [abstract]. CJEM 2000;2(3):180.Google Scholar
9.Hill, MD, Buchan, AM, for the CASES study group. The Canadian Activase for Stroke Effectiveness Study (CASES) [abstract]. Can J Neurol Sci 2000;27 (suppl 2):S25.Google Scholar
10.Shuaib, A, Hill, MD, Buchan, AM.Interval times in the Canadian Activase for Stroke Effectiveness Study. Interim Analysis [abstract]. Clin Invest Med 2000;23 (suppl):S9.Google Scholar
11.Teal, P, Woolfenden, A, Hill, MD, Buchan, AM.Interval times for the Canadian Activase for Stroke Effectiveness Study (CASES). Interim analysis [abstract]. Can J Cardiol 2000;16(Suppl F):140F.Google Scholar
12.Barber, PA, Demchuk, AM, Zhang, J, Buchan, AM for the ASPECTS Study Group. Validity and reliability of a quantitative computed tomographic score in predicting outcome of hyperacute stroke before thrombolytic therapy. Lancet 2000;355:1670–4.Google Scholar
13.Naylor, CD, Armstrong, PW, for the Ontario Medical Association Consensus Group on Thrombolytic Therapy. Guidelines for the use of intravenous thrombolytic agents in acute myocardial infarction. CMAJ 1989;140:1289–99.Google Scholar
14.Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomized trials of organized inpatient (stroke unit) care after stroke. BMJ 1997; 314:1151–9.CrossRefGoogle Scholar
15.Wilson, E, Taylor, G, Phillips, S, Stewart, PJ, Dickinson, G, Ramsden, VR, et al, for the Canadian Stroke Systems Coalition. Creating a Canadian stroke system. CMAJ 2001;164(13):1853–5.Google Scholar