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Review: thrombolysis increases short term death and intracranial haemorrhage but decreases long term death or dependence

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 QUESTION: In patients with acute ischaemic stroke, is thrombolytic treatment safe and effective for reducing mortality and intracranial haemorrhage, and for improving functional outcome?

Data sources

Studies were identified by searching the Cochrane Specialised Register of Controlled Trials and EMBASE/Excerpta Medica, hand searching neurological and stroke journals, writing to 321 pharmaceutical companies for information, and reviewing meeting abstracts and conference proceedings.

Study selection

Studies were selected if they were randomised controlled trials that compared thrombolytic drugs with placebo or control treatment in patients with definite acute ischaemic stroke. Trials were excluded if the treatment or control group received another active treatment not factored into the randomisation.

Data extraction

Data were extracted on patients, drug dose, administration route, duration of treatment, stroke type, results of computed tomography, and duration of follow up. Outcomes were all-cause mortality 7 to 10 days after treatment, symptomatic or fatal …

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  • For correspondence: Professor J M Wardlaw, Western General Hospital, Edinburgh, Scotland, UK. jmw{at}

  • Source of funding: no external funding.