Stroke thrombolysis remains unproven: per ardua, ad astra …

Is telemedicine helping or hindering the delivery of stroke thrombolysis in rural areas? A qualitative analysis

“…These sentiments had important implications for stroke telemedicine acceptance and utilisation at this hospital since the main focus of implementing telemedicine was to increase access to stroke thrombolysis, and were despite the fact that there was an existing local stroke protocol for use of thrombolysis in the ED at this hospital as recommended in the national clinical guidelines for acute stroke. 3 While there is evidence to suggest that doctors' interpretation of the treatment evidence can be a barrier to delivering thrombolysis, 47,48 our results highlight how the systematic controversy [7][8][9][10][11][12]49,50 among different medical groups about thrombolysis directly impacts on what treatment options are potentially offered to patients. The perceived need to use telemedicine to assist in acute stroke care was very much moderated by different regional health profession-als' views about the usefulness of rt-PA in acute stroke.…”

“…Expertise is needed due to a possible misdiagnosis of stroke mimics and a potential risk of intracerebral haemorrhage if administered to patients who are inappropriate for the treatment . Although recent meta‐analytic work illustrates the effectiveness of rt‐PA regardless of age and stroke severity and its cost‐effectiveness, this treatment is not without controversy . For example, in the statement on intravenous thrombolysis for ischaemic stroke (updated March 2014), The Australian College of Emergency Medicine states that ‘it cannot currently be considered a “standard of care” ’.…”

“…3 Although recent metaanalytic work illustrates the effectiveness of rt-PA regardless of age and stroke severity 5 and its cost-effectiveness, 6 this treatment is not without controversy. [7][8][9][10][11][12][13] For example, in the statement on intravenous thrombolysis for ischaemic stroke 7 (updated March 2014), The Australian College of Emergency Medicine states that 'it cannot currently be considered a "standard of care" '. In turn, however, Fitzgerald and Gerraty 14 indicated that 'A coordinated system of care for stroke and transient ischaemic attack in Australia has been stalled by the lack of a concerted effort to adopt thrombolysis'.…”

Author reply

“…I welcome the opportunity to respond to the letter from Fatovich and Brown. 1 From the outset, it is unfortunate, if not worrying, that the authors appear sceptical of the need to treat acute stroke promptly, an approach left behind in the past century. We know that 'time is brain'.…”