Posted by Ryan Radecki
It’s been 5 years since the last Cochrane Review synthesizing the evidence regarding tPA in acute ischemic stroke. Clearly, given such a time span, in an area of active clinical controversy, a great deal of new, important, randomized evidence has been generated!Or, sadly, the only new evidence available to inform practice is IST-3 – a study failing to demonstrate benefit, despite its pro-tPA flaws and biases. So, it ought not be a very exciting update, considering the 2009 version included 26 trials, and the 2014 update now includes only 27 trials. Their summary conclusion, with only additional evidence of regression to the mean, ought remain essentially the same, or even less optimistic, right?
Of course not:
via Emergency Medicine Literature of Note: The tPA Cochrane Review Takes Us For Fools.
Read, and enjoy. Excellent analysis.
I think the tipping point is in the rearview mirror and we are now to do what we’ve been told. Unless of course, there is a bad outcome, then it is clearly the doctor’s fault regardless of whether or not you followed the guidelines.