> I'm not sure I follow, does this imply fibrinolytics are dangerous drugs by default for the elderly population that tends to get strokes? Are they just dangerous in general?
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.
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.