Reperfusion Therapy – Concerns about the Evidence

Over 27 trials have been conducted on the immediate hazards and the apparent net benefit of thrombolytic therapy [20].

Concerns remain over evidence quality, particularly amongst Emergency Physicians.

The Royal College of Emergency Medicine issued a position statement in 2015 recognising ‘that there is controversy and some scientific concern about whether to provide thrombolysis for patients who have suffered an acute ischaemic stroke’ [27]. Only 10% of hospitals in the UK have an ED consultant on their thrombolysis rota [21].

The American College of Emergency Physicians also downgraded the use of thrombolysis from a Level A to a Level B recommendation in 2015 [28].

See the for a further discussion of the merits of thrombolysis studies [29].

You should be aware of the local policies that apply in your department and discuss any concerns with your local stroke lead.