The Risk of Stroke after Thrombolytic Therapy

To the Editor: In their editorial (July 2 issue),¹ Topol and Califf state that the excess risk of cerebral hemorrhage observed with tissue plasminogen activator (t-PA) as compared with streptokinase was more pronounced among elderly patients than among young patients when a fixed-dose t-PA regimen was used in the second study by the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico) (GISSI-2),² but not when a weight-adjusted t-PA regimen was used in the Third International Study of Infarct Survival (ISIS-3).³ This does not, however, reflect the published data from these studies (Table 1).Moreover, in GISSI-2,¹ body-mass index was . . .