This is a reason why there is a lack of consensus on lytics for #stroke:
- 13 foundational RCTs
- 4 stopped early for harm or futility
- 8 of 13 used tPA
- Only 2 reported benefit for primary outcome
- Neither were replicated
-Both reanalyzed & failed to confirm benefit.
- 13 foundational RCTs
- 4 stopped early for harm or futility
- 8 of 13 used tPA
- Only 2 reported benefit for primary outcome
- Neither were replicated
-Both reanalyzed & failed to confirm benefit.
This lack of consistent evidence for potential benefit combined with the evidence of increase for potential harm (ICH&death) is a reason we (@First10EM) downgraded the NNT recommendation to yellow. It highlights the uncertainty of the existing evidence. thennt.com/nnt/tissue-pla…
I've was asked what the majority of EM think about tPA for stroke? Found @epmonthly poll when ACEP updated guidelines in 2013 to level "A". It reported 88% thought guidelines should be revised/rescinded. They were then downgraded to Level B&C in 2015. acep.org/patient-care/c…
This is consistent with the 75% of EM leadership (hundreds of council members) who voted to reconsider the 2013 level "A" recommendation.
It resulted in an updated 2015 policy with no level A recommendations and only level B&C.
@GillianMD1 @EverydayMed acepnow.com/article/acep-c…
It resulted in an updated 2015 policy with no level A recommendations and only level B&C.
@GillianMD1 @EverydayMed acepnow.com/article/acep-c…
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