, Volume 8, Issue 8, pp 651-652
Date: 23 Aug 2013

Italian guidelines on thrombolysis indications in ischemic stroke have been revised after IST-3 trial and Cochrane revision: cons

This is an excerpt from the content

One of the milestones of evidence-based medicine is the critical appraisal [1]. Critical appraisal shifts clinical practice from eminence-based medicine (medicine based on authority) to evidence-based medicine (medicine based on the proof and the judgment of the proof). Clinical practice guideline recommendations should be based on the best available evidence. Therapeutic recommendations should be developed upon randomized controlled trials (RCTs) with clinically relevant (defined as “hard”) primary end points, low risk of bias, rigorous internal validity and good external validity [2]. The Italian guidelines on thrombolysis indications in ischemic stroke [3] have been revised after the IST-3 trial [4]. Does IST-3 satisfy the above-mentioned RCT characteristics providing the best evidence on which a clinical practice guideline should be modified?

When the IST-3 trial was published many considered it the end of the struggle between “pros” and “cons” about thrombolysis [57]. Indeed IST-3 ...