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Thrombolysis with alteplase 3–4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances
  1. Daniel Michael Fatovich1,2,
  2. Wm Ken Milne3
  1. 1 Emergency Medicine, Faculty of Health and Medical Sciences, Royal Perth Hospital, University of Western Australia, Perth, Western Australia, Australia
  2. 2 Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
  3. 3 Department of Medicine, Western University, London, Ontario, Canada
  1. Correspondence to Professor Daniel Michael Fatovich, Emergency Medicine, Faculty of Health and Medical Sciences, Royal Perth Hospital, The University of Western Australia, Perth, WA 6847, Australia; daniel.fatovich{at}

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We congratulate Alper et al for their reanalysis of the Third European Cooperative Acute Stroke Study.1 They found that after adjusting for baseline imbalances in history of prior stroke and stroke severity, there was no statistical benefit with alteplase, but the harms were reconfirmed. So, the difference in outcome could be fully explained by the baseline imbalance. It is worth remembering that a clinical trial has internal validity if and only if the imbalance between groups, bias in …

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  • Contributors Both authors made equal contributions to the content. Both authors have written and spoken on this subject.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.