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;375:1695-1703). 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.
Mitka M. Some Suggest Wider Therapeutic Window for Offering Alteplase to Treat Stroke. JAMA. 2010;304(2):146. doi:10.1001/jama.2010.875