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The timely review¹ regarding tissue plasminogen activator (tPA) use for acute stroke implies that some physicians' reluctance to prescribe tPA is attributable to their unjustified fear of cerebral hemorrhage for patients and litigation and poor pay for themselves. Because the reviewers' earnest premise is that tPA "increases recovery from stroke symptoms by up to 50% with a low serious complication rate," they imply that choice should be certain. But a fourth factor to consider is that equally conscientious evaluation of the complex database by professional colleagues may be less enthusiastic.

The original 1995 reference² states that at 3 months, not earlier,

As compared with the placebo group, there was a 12% absolute (32% relative) increase in the number of patients with minimal or no disability (a score of 95 or 100 on the Barthel index) in the tPA group. There was also an 11% absolute (55% relative) increase in the . . . [Full Text of this Article]

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