Tissue Plasminogen Activator for Acute Ischemic Stroke

To the Editor: In “Tissue Plasminogen Activator [t-PA] for Acute Ischemic Stroke” (Dec. 14 issue), 1 it is reported that treatment with t-PA increases a patient's chance of recovering from an ischemic stroke without any, or only minimal, disability or neurologic deficit. Despite this optimistic conclusion, several methodologic issues and the demonstrated risks of treatment with t-PA suggest a more cautious interpretation. Although the study was randomized, there were important base-line differences that favored the t-PA–treated patients. Overall, more patients in the t-PA–treated group than in the placebo group had been receiving aspirin before the event (odds ratio, 1.697; 95 percent . . .