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Stroke care in Australia: why is it still the poor cousin of health care?

To the Editor: In their editorial on stroke care in Australia, Hoffman and Lindley state “only 7% of ischaemic stroke patients received thrombolysis treatment, yet for every 100 patients who receive it, there are up to 10 extra independent survivors”,1 citing the most recent meta-analysis.2 This research also found a significant increase in the risk of early death with thrombolysis, mostly from intracranial haemorrhage. For the individual patient, predicting final neurological outcome is difficult in the early hours after the onset of stroke. Patients considering thrombolysis treatment must weigh up an increased risk of early death against possible improvement in final function if they survive. In addition, any benefits from thrombolysis appear modest at best.

The third International Stroke Trial (IST-3), the most recently published and largest randomised trial of thrombolysis in stroke, in fact showed no improvement in the proportion of patients alive and independent at 6 months.3 Hoffman and Lindley describe a number of evidence–practice gaps, including early assessment for transient ischaemic attack and access to multidisciplinary stroke unit care. Patients and the community may…