%0 Journal Article
%T Effect of erythropoietin therapy on clinical outcome in patients after acute ischemic stroke: a debatable issue
%A Chun-Man Yuen
%A Cheuk-Kwan Sun
%A Steve Leu
%A Hon-Kan Yip
%J Critical Care
%D 2011
%I BioMed Central
%R 10.1186/cc10145
%X We thank Minnerup and colleagues [5] for their comments in the previous issue of Critical Care. These authors suggested that, for evaluating 90-day neurological outcome, the modified Rankin Scale or the Barthel Index could be superior to the National Institutes of Health Stroke Scale (NIHSS) that was used in our study [5]. They also mentioned that, when the components of the composite endpoint in our study protocol are considered, the significantly higher number of patients with an NIHSS score of at least 8 after placebo treatment is also likely to be caused by the high rate of recurrent strokes and does not necessarily reflect improved neurological function in the EPO group [5]. However, NIHSS is widely accepted as one of the most efficacious tools for evaluating neurological outcome after acute IS. Additionally, the trial in our study was prospective, randomized, and placebo-controlled - this is the best design to minimize the selection bias between the study group and the control group. Accordingly, we suggest that the significantly lower number of patients with an NIHSS score of at least 8 in the EPO group in comparison with the placebo group could reflect simply the therapeutic benefit of EPO therapy in improving the 90-day neurological outcome rather than a mere speculation of a higher rate of recurrent strokes in the placebo group.The optimal dosage of EPO and duration of treatment for patients after IS remain uncertain. This may account for some inconsistency in improvement of neurological outcome after IS in clinical trials [1-4]. Accordingly, we disagree with Minnerup and colleagues [5] that 'the potential side effects and the failed efficacy in large clinical trials will presumably prevent the use of EPO as a therapy to increase EPCs after stroke'.Minnerup and colleagues also underscored that the study was first assigned to a trial register (ISRCTN 96340690) in January 2011, which was 10 months after the inclusion of the last patients in March 2010 [5]. W
%U http://ccforum.com/content/15/3/425