Why not take fibrinolytics before the scan, just to be on the safe side? Ambulances could be equipped with fibrinolytics, for instance.
Is it because fibrinolytics could actually be harmful, depending on the stroke type?
A CNS hemorrhage can present similarly, but giving these meds would be a death sentence in this case.
>with a change in the primary outcome to highlight the small benefit found at 30d
So does that mean "time is brain" is a bit exaggerated then, if the benefits are small?
These meds need be given within 3-6 hours of stroke onset, depending on who you ask and what heroics you want to accomplish. After the six hour mark, you’re facing the same risks of disability from an iatrogenic bleed versus little gain from therapy because hypoxic tissue is dead at that point.
However, before that window closes, there is significant benefit in doing something versus nothing in stroke. It’s great when the use of the agent results in no deficits. The same can be said when the results are only limited deficits (i.e. use of a cane) versus a wheelchair or admission to long-term care.
Dangerous in general, especially for patients with acute stroke. Thankfully the risk of an intracranial bleed is much lower for patients without a stroke (~1% IIRC), so if you get the diagnosis wrong (as there are many mimics) at least the risk isn't as high.
> So does that mean "time is brain" is a bit exaggerated then, if the benefits are small?
¯\_(ツ)_/¯ -- my impression is that the "time is brain" is emphasizing that "earlier is better," which is absolutely the case. Unfortunately, better is not always "good."
Thankfully, for massive strokes, we now have much more effective options (which are generally performed along with tPA). Unfortunately these options require highly trained subspecialists that my be practically unavailable to rural hospitals.