FOAM WORKS – THE IST-3 INCIDENT

FOAM – Free Open-Access Meducation – as coined by Mike Cadogan, has been the recent label put on the medical blogging world’s posting and discussing of medical topics online. Do a #FOAMed search on Twitter, and you’ll get a lot of interesting links. The blogging world of medicine is a great way to learn, and one example is the recent publishing of the IST-3 trial on thrombolysis in stroke, and the discussion that followed.

The IST- 3 trial
“The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial” was published in the Lancet 23rd of June 2012. It was the largest and arguable most prestigeous trial for thrombolysis in stroke. Everyone was cheering on them – hoping thrombolysis worked. And the IST-3 trial concluded it did!

The blogging world roars
The sad part is that the IST-3 numbers don’t really support that conclusion. The IST-3 numbers couldn’t really prove any benefit on the primary endpoints. So the authors did some subgroup analysis and a secondary endpoint shuffle. Some smart doctors commented on this fact online, and a big debate was sparked on twitter and various blogs. One of the best summaries were posted here: Thrombolysis in Stroke – Are We Done Yet? – slaughtering the IST-3 collaberative’s conclusion. A highly recommended read, incuding the pasted comments.

The Lancet follows
Now, some months later an editorial in the Lancet, who published the article in the first place, says the same thing – in a slightly nicer way. Normally, this kind of revelation in a Lancet editorial would have been a small bomb for me. Now, it was old news. Viva la revolution!

The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial, The Lancet, 23rd June 2012.

Thrombolysis in Stroke – Are We Done Yet?, EDTCC blog, 13th July 2012.

Thrombolysis in acute ischaemic stroke – editorial, The Lancet, 23rd Sept 2012.

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