I read the article by Saposnik et al.1 with interest. Without a control group with a positive Stroke Prognostication using Age and NIHSS (SPAN)–100, it is difficult to know whether giving tissue plasminogen activator (tPA) is of benefit. Studies have shown that the elderly benefit from tPA, so that leaves the severity of the stroke as measured by the NIHSS Score as the main determinant of a good outcome.
Nevertheless, the article is a useful tool with which to counsel families and substitute decision-makers who must often decide for the aphasic patient whether to give tPA in SPAN-100 patients.
Author Response
We thank Dr. Yufe for his comments regarding our article.1 Regarding the control group for the SPAN-100, figures 1 and 2 and table 2 provide a comparison of multiple outcomes between SPAN-100 patients receiving tPA and placebo. SPAN-100 patients receiving tPA had higher risk of intracerebral hemorrhage compared to SPAN-100 in the placebo group. No significant benefit was observed in functional clinical outcomes, allowing for a small sample size. Age and stroke severity are the 2 major predictors of stroke outcomes. Although these results need to be validated in a larger dataset, they are useful when counseling ischemic stroke patients and their families.
References
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- © 2013 American Academy of Neurology
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