We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
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—Reply

Bruce Ovbiagele, MD, MSc, MAS1; Gustavo Saposnik, MD, MSc, FRCPC2
[+] Author Affiliations
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.
Text Size: A A A
Published online


In Reply We thank Dr Little for his interest in our article.1 Dr Little is correct in that “[t]he VISTA database does not sanction reanalysis of any trial data that will test treatment effects….” However, our observational study did not set out to reanalyze the efficacy of a given thrombolytic agent, but rather to assess the impact of thrombolytic agents administered as part of routine clinical practice in acute stroke trials of neuroprotective agents. We should also emphasize that our study should only be viewed as hypothesis generating. Indeed, the observation that older patients with more severe strokes gain more from intravenous thrombolysis treatment on an absolute scale simply leads to the conclusion that this group of patients may not necessarily have to be denied treatment just on the basis of age or stroke severity and that more study of intravenous thrombolysis use in elderly patients with severe strokes is needed. Finally, the lack of efficacy of intravenous thrombolysis in the SPAN-100–negative patients might have been because the nonrandomized assignment led to a residual treatment selection bias.


Sign in

Purchase Options

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

First Page Preview

View Large
First page PDF preview





October 1, 2014
Neal E. Little, MD
1Chelsea Community Hospital, Chelsea, Michigan2Emergency Physicians Medical Group PC, Ann Arbor, Michigan
JAMA Neurol. 2014;71(10):1326. doi:10.1001/jamaneurol.2014.2294.
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.


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

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...