Dr. Santulli, citing the findings of Dr. Mishra et al. that neither diabetes nor prior stroke affected thrombolysis outcomes, calls for the reevaluation of thrombolysis criteria and the adoption of a clinical score, similar to that used in acute coronary syndrome, to stratify risk. There were 2 WriteClick submissions in reference to the recent article by Dr. Stein et al. comparing high-dose and low-dose vitamin D2 supplementation in relapsing-remitting multiple sclerosis. Dr. Leitner calls attention to the incongruity of epidemiologic trends in MS vs another vitamin D–related illness, rickets, as further reason not to supplement patients with MS without proven vitamin D deficiency at this time. Dr. Grimaldi et al. argue that the study was underpowered and potentially biased. Their own phase II study of high-dose vitamin D3 supplementation is under way. Megan Alcauskas, MD, and Robert C. Griggs, MD
Mishra et al.1 examined the influence of diabetes mellitus and prior stroke on the outcomes of patients who received thrombolysis vs nonthrombolyzed controls. They found no interaction on outcome between diabetes and prior stroke with thrombolysis treatment.
These results conflict with the European Medicines Evaluation Agency's justification for restricting the use of IV alteplase. As Dr. Demaerschalk mentioned in the accompanying editorial,2 recent studies1,3,4 have suggested that thrombolysis can be safely used in several groups of patients who do not qualify for treatment due to strict application of exclusion criteria.
In addition, most of the commonly cited thrombolytic exclusion criteria are just consensus-based, not evidence-based.2,3 It is time to reevaluate the criteria for thrombolysis, adopting a clinical score to stratify the risk, similar to those used in acute coronary syndrome.5 A good risk assessment tool will be able to identify a gradient of mortality risk by using variables that capture the majority of prognostic information to better evaluate the risk/benefit ratio for each patient.
- Copyright © 2012 by AAN Enterprises, Inc.
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