Ethical issues in stroke thrombolysis revisitedBack in 1997, a bioethical paper on intravenous thrombolysis in acute ischaemic stroke (IVT), authored by Anthony J. Furlan and George Kanoti, was published. 1 Based on the criteria modified from Schwartz 2 (safety, efficacy, effectiveness, efficiency and outcome), the authors found several ethical problems that were associated with IVT. They can be summarised as a weak proportionality between positive and negative outcomes, and a lack of relation to patient preferences.The literature on IVT has continued to grow after 1997. Most randomised studies on alteplase were published after that, and the debate on IVT has continued to be lively, even over the last decade. [3][4][5][6][7][8][9] Time has therefore come to revisit the ethical issues raised in 1997. The purpose of this paper is to analyse whether these issues have been resolved. More specifically, the following issues will be reviewed as follows:1. Lack of standardisation of outcome endpoints.2. A poorly substantiated beneficial effect.3. Unsolved safety problems, that is an increased risk of intracranial haemorrhage and death.4. Uncertainties regarding patient preferences.
Difficulties in obtaining informed consent.As alteplase is the most studied thrombolytic drug, 10 we will solely deal with this drug. Each section will be commence with a