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Medical News & Perspectives
July 14, 2010

Some Suggest Wider Therapeutic Window for Offering Alteplase to Treat Stroke

JAMA. 2010;304(2):146. doi:10.1001/jama.2010.875

Momentum is building for extending the time window for giving recombinant tissue-type plasminogen activator (alteplase) to patients having an ischemic stroke, although some caution that doing so will increase the likelihood of treatment-related adverse events.

The latest push comes after the May 15 publication of a pooled analysis of 8 randomized placebo-controlled trials of alteplase for acute stroke, which is currently indicated for use only within 3 hours after stroke onset. The analysis, which involved 3670 patients, found benefit if the drug is administered within 4.5 hours after stroke onset (Lees KR et al. Lancet. 2010;375[9727]:1695-1703). But after 3 hours of stroke onset, the percentage of patients achieving benefit steadily decreases with time, with no benefit and an increased risk of death seen beyond 4.5 hours.

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