IST-3: more a sunset for stroke lysis than a false dawn

The illustrious David Newman of and speaks, and agrees with me. IST-3 is a debacle!

“With advances in scientific literacy it has been years since I have seen a top journal allow authors to proclaim a conclusion in direct conflict with their own primary study results. And yet the authors blithely conclude that thrombolytics “improved functional outcome.” Worse, an accompanying editorial trumpets that “the role of stroke and emergency physicians is now not to identify patients who will be given rt-PA, but to identify the few who will not.” Welcome to Wonderland.

These statements feel not just forced, but frankly delusional. Has neuro gone psycho? The results of IST-3 indicate, at best, a profound disappointment (even the hallucinated benefit would be tinier than any previously claimed) and at worst the beginning of the end for thrombolytics in stroke. In either case, reality may be tough to handle, but it is not a matter of debate, or interpretation, or perception. The primary outcome failed. We have a phrase for that: no benefit

So, more extreme than my own view, in that I still believe this will be a good therapy for SOME patients – we just haven’t got good data to tell us who those patients are yet, and this should be the direction of future research.


About dreapadoir

Emergency Physician, author of Emergency Medicine blog, photographer at
This entry was posted in Discussions and rants, Education, Medical Musings, Writing. Bookmark the permalink.

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