"Two per cent isn't a lot, but when it comes to death it seems quite a lot anyway": patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment for acute stroke

J Med Ethics. 2009 Jan;35(1):42-6. doi: 10.1136/jme.2007.023192.


Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome.

Objective: To explore acute stroke patients' perception of risk and willingness to accept risks associated with thrombolytic drug treatment.

Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews.

Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients' willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients' reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions.

Conclusion: Acute stroke patients' difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Attitude to Death
  • Cerebral Hemorrhage / chemically induced*
  • Ethics, Medical
  • Female
  • Fibrinolytic Agents / adverse effects*
  • Humans
  • Informed Consent / ethics*
  • Informed Consent / psychology
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care / psychology*
  • Risk Assessment
  • Stroke / complications
  • Stroke / drug therapy*


  • Fibrinolytic Agents