Thrombolytic therapy for acute ischemic stroke beyond three hours

Christopher R. Carpenter, Samuel M Keim, William Kenneth Milne, William J. Meurer, William G. Barsan

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Background: Ischemic cerebrovascular accidents remain a leading cause of morbidity and mortality. Thrombolytic therapy for acute ischemic stroke within 3 h of symptom onset of highly select patients has been advocated by some groups since 1995, but trials have yielded inconsistent outcomes. One recent trial demonstrated significant improvement when the therapeutic window was extended to 4.5 h. Clinical Question: Does the intravenous systemic administration of tPA within 4.5 h to select patients with acute ischemic stroke improve functional outcomes? Evidence Review: All randomized controlled trials enrolling patients within 4.5 h were identified, in addition to a meta-analysis of these trial data. Results: The National Institute of Neurological Disorders and Stroke (NINDS) and European Cooperative Acute Stroke Study III (ECASS III) clinical trials demonstrated significantly improved outcomes at 3 months, with increased rates of intracranial hemorrhage, whereas ECASS II and the Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study showed increased hemorrhagic complications without improving outcomes. Meta-analysis of trial data from all ECASS trials, NINDS, and ATLANTIS suggest that thrombolysis within 4.5 h improves functional outcomes. Conclusion: Ischemic stroke tPA treatment within 4.5 h seems to improve functional outcomes and increases symptomatic intracranial hemorrhage rates without significantly increasing mortality.

Original languageEnglish (US)
Pages (from-to)82-92
Number of pages11
JournalJournal of Emergency Medicine
Volume40
Issue number1
DOIs
StatePublished - Jan 2011

Fingerprint

Thrombolytic Therapy
Stroke
National Institute of Neurological Disorders and Stroke
Intracranial Hemorrhages
Meta-Analysis
Mortality
Intravenous Administration
Therapeutics
Randomized Controlled Trials
Clinical Trials
Morbidity

Keywords

  • EBM
  • meta-analysis
  • randomized controlled trial
  • stroke
  • thrombolysis

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Thrombolytic therapy for acute ischemic stroke beyond three hours. / Carpenter, Christopher R.; Keim, Samuel M; Milne, William Kenneth; Meurer, William J.; Barsan, William G.

In: Journal of Emergency Medicine, Vol. 40, No. 1, 01.2011, p. 82-92.

Research output: Contribution to journalArticle

Carpenter, Christopher R. ; Keim, Samuel M ; Milne, William Kenneth ; Meurer, William J. ; Barsan, William G. / Thrombolytic therapy for acute ischemic stroke beyond three hours. In: Journal of Emergency Medicine. 2011 ; Vol. 40, No. 1. pp. 82-92.
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