Current controversies: thrombolysis for patients with acute ischaemic stroke aged over 80

Stroke is the major cause of disability in the community. Most strokes are due to blocked arteries in the brain. Evidence is accumulating that clot-busting drugs improve outcome after ischaemic stroke. Recombinant tissue plasminogen activator (rt-PA) is licensed for the treatment of selected patients within three hours of acute ischaemic stroke in many parts of the world, and stroke services are being developed so that eligible patients can receive this treatment as soon as possible after the onset of stroke symptoms. However, thrombolysis can cause bleeding into the brain, so the treatment should only be given when the benefits outweigh the risks. Controversy still exists about the risks and benefits in certain groups of patients, and there is variation in practice between stroke physicians, reflecting these uncertainties. The JRCPE editorial team is delighted that two leading experts have agreed to debate the pros and cons of thrombolysis in people over the age of 80 years; one of the areas where there is still variation in practice. We hope that readers will find this debate enlightening, entertaining and informative.