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Randomised controlled trial
Odds of favourable 3-month outcome following ischaemic stroke are greatest when treatment with intravenous alteplase is initiated up to 90 min following event, with no benefit seen if alteplase is given after 270 min
  1. Richard I Lindley
  1. Discipline of Medicine, Sydney Medical School - Westmead, The University of Sydney, New South Wales, Australia
  1. Correspondence to Richard I Lindley
    Westmead Hospital (C24), The University of Sydney, NSW 2006, Australia; richard.lindley{at}

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Thrombolysis for acute ischaemic stroke is an effective treatment that has been extremely difficult to implement. Of the many barriers to implementation (eg, delayed admission to hospital and poor acute stroke infrastructure), the very short treatment window has been the most challenging. Alteplase has generally only been approved for treatment up to 3 h from stroke onset. This study specifically addresses the effectiveness of alteplase by treatment delay.


This updated individual patient meta-analysis incorporates new data from two further completed randomised controlled trials, ECASS III (821 patients) and EPITHET (100 patients), with all included trials having a time window of less than 6 h. The population consisted of patients in seven completed trials over the past two decades. They excluded patients who were treated after 6 h, therefore the analysis is not ‘intention to treat’. The included trials were double blind but because of the difficulty of masking the biological effects of alteplase, …

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  • Competing interests RIL has been supported by Boehringer Ingelheim for attending national stroke and cardiovascular conferences. He is the Co-Principal Investigator of the Third International Stroke Trial (IST-3).