0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

Risk Index and Thrombolytic Treatment in Acute Ischemic Stroke

Neal E. Little, MD1,2
[+] Author Affiliations
1Chelsea Community Hospital, Chelsea, Michigan
2Emergency Physicians Medical Group PC, Ann Arbor, Michigan
JAMA Neurol. 2014;71(10):1326. doi:10.1001/jamaneurol.2014.2294.
Text Size: A A A
Published online

Extract

To the Editor In the article by Ovbiagele et al1 published in JAMA Neurology—which tested the hypothesis that patients with stroke with a positive SPAN-100 index (the sum of a patient’s age plus National Institutes of Health Stroke Scale of 100 or greater) selected from the Virtual International Stroke Trials Archive (VISTA) database might benefit from thrombolysis—the authors concluded that such SPAN-100–positive patients “should probably not be denied thrombolysis treatment on the basis of such a profile alone.” Likewise they conclude that “the answer to the question posed about what to do regarding very elderly patients with very severe strokes…seems to be to treat them with intravenous thrombolysis….” They concluded this from finding that the SPAN-100 patients in their selection from the VISTA database treated with thrombolysis did better than those who did not receive that treatment (adjusted odds ratio, 0.46 [95% CI, 0.29-0.71]) The many limitations noted by the authors of querying the artificially created VISTA database are delineated and are very significant, yet do not seem to prevent the authors from making such treatment recommendations. This is also counter to the VISTA database founders stating that “[t]he VISTA database does not sanction reanalysis of any trial data that will test treatment effects….”2

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

October 1, 2014
Bruce Ovbiagele, MD, MSc, MAS; Gustavo Saposnik, MD, MSc, FRCPC
1Department of Neurosciences, Medical University of South Carolina, Charleston
2Stroke Outcomes Research Unit, Division of Neurology, University of Toronto, Toronto, Ontario, Canada
JAMA Neurol. 2014;71(10):1326. doi:10.1001/jamaneurol.2014.2297.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

241 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();