Skip to main content

Main menu

  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us

Clinical Medicine Journal

  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

User menu

  • Log in

Search

  • Advanced search
RCP Journals
Home
  • Log in
  • Home
  • Our journals
    • Clinical Medicine
    • Future Healthcare Journal
  • Subject collections
  • About the RCP
  • Contact us
Advanced

Clinical Medicine Journal

clinmedicine Logo
  • ClinMed Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Author guidance
    • Instructions for authors
    • Submit online
  • About ClinMed
    • Scope
    • Editorial board
    • Policies
    • Information for reviewers
    • Advertising

Hyper acute stroke unit services

Nigel Dudley
Download PDF
DOI: https://doi.org/10.7861/clinmedicine.11-5-508
Clin Med October 2011
Nigel Dudley
St James's University Hospital, Leeds
Roles: Consultant in elderly medicine
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Info & Metrics
Loading

Simon Liu and colleagues (Clin Med June 2011) should have clarified that the quoted number needed to treat (NNT) of 3.1 with thrombolysis did not refer to the more often used group outcome comparison of ‘independent’ versus ‘dependent and dead’, but to expert derived estimates for one additional patient to have a better outcome by one or more grades on the mRS (modified Rankin Score).1,2 This would include patients moving from mRS 5 to mRS 4, for example, who would remain in the ‘dependent and dead’ category of outcome.

Jeffrey Saver's 2004 modelling paper concluded ‘for every 100 patients with acute stroke treated with tissue plasminogen activator, approximately 32 will have a better final outcome and three have a worse final outcome as a result of treatment’. Thrombolysis has the potential to harm as well as cure! Saver also stated in the paper ‘the NNT for tPA treatment to avert one case of dependence or death after stroke, defined as an mRS of 2 or more, is 8.4’ based on the NINDS study.2 A NNT of 8–10 is probably more recognised by physicians for the effectiveness of thrombolysis.

Work from Australia documenting the real-life three-month outcomes after thombolysis suggests that Saver's experts may have underestimated the benefits of thrombolysis in the group of patients presenting with more severe strokes.3 Bray and colleagues in Melbourne found that of 24 patients presenting with stroke and a mRS of 4, the outcome at three months was that five of the group had an mRS of 0, 6 mRS of 1, 3 mRS of 2, 5 mRS of 3 and 1 an mRS of 4. Only four patients had a worse outcome with one dying (mRS 6) and three having a mRS of 5. For the 43 patients presenting with a mRS of 5 there were similar favourable improvements; 19 returned to independence (mRS 0–2) at three months post-stroke, with a further six dying and five remaining on a mRS of 5.

The access to hyper acute stroke care and thrombolysis in London has improved in recent years. Those people with severe strokes in particular need to get to hospital as soon as possible because early thrombolysis could make a major difference to their future care needs.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2011 Royal College of Physicians

References

  1. ↵
    1. Saver JL
    Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke Arch Neurol 2004 61 1066–70doi:10.1001/archneur.61.7.1066
    OpenUrlCrossRefPubMed
  2. ↵
    NINDS rt-PA Stroke Group Tissue plasminogen activator for acute ischaemic stroke N Engl J Med 1995 333 1581–7doi:10.1056/NEJM199512143332401
    OpenUrlCrossRefPubMed
  3. ↵
    1. Bray JE,
    2. Coughlan K,
    3. Bladin C
    Thrombolytic therapy for acute ischaemic stroke: successful implementation in an Australian tertiary hospital Int Med J 2006 36 483–8doi:10.1111/j.1445-5994.2006.01127.x
    OpenUrlCrossRefPubMed
Back to top
Previous articleNext article

Article Tools

Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Citation Tools
Hyper acute stroke unit services
Nigel Dudley
Clinical Medicine Oct 2011, 11 (5) 508; DOI: 10.7861/clinmedicine.11-5-508

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Hyper acute stroke unit services
Nigel Dudley
Clinical Medicine Oct 2011, 11 (5) 508; DOI: 10.7861/clinmedicine.11-5-508
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Footnotes
    • References
  • Info & Metrics

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • SARS-CoV-2 infection despite vaccination: an under-reported COVID-19 cohort
  • Mitral stenosis-related pulmonary embolism as a potential cause of vocal cord paralysis
  • JAK-inhibition as a therapeutic strategy for refractory primary systemic vasculitides
Show more Letters to the editor

Similar Articles

Navigate this Journal

  • Journal Home
  • Current Issue
  • Ahead of Print
  • Archive

Related Links

  • ClinMed - Home
  • FHJ - Home
clinmedicine Footer Logo
  • Home
  • Journals
  • Contact us
  • Advertise
HighWire Press, Inc.

Follow Us:

  • Follow HighWire Origins on Twitter
  • Visit HighWire Origins on Facebook

Copyright © 2021 by the Royal College of Physicians