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  • Timing of thrombolysis for acute ischaemic stroke: the earlier the treatment the better the outcome, irrespective of age or stroke severity

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Therapeutics/Prevention
Randomised controlled trial
Timing of thrombolysis for acute ischaemic stroke: the earlier the treatment the better the outcome, irrespective of age or stroke severity
  1. Svetlana Lorenzano
  1. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
  1. Correspondence to : Dr Svetlana Lorenzano, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; svetlana.lorenzano{at}uniroma1.it

https://doi.org/10.1136/ebmed-2014-110155

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    Commentary on: Emberson J, Lees KR, Lyden P, et al., Stroke Thrombolysis Trialists’ Collaborative Group. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014;384:1929–35OpenUrlCrossRefPubMedWeb of Science.

    Context

    In patients with acute ischaemic stroke (AIS) intravenous thrombolysis with alteplase (t-PA) is the only effective treatment and it is approved within three or four and a half hours of symptom onset based on regulatory area. This study looked at how treatment delay, patient age and stroke severity influence the effect of t-PA in AIS in terms of functional outcome, mortality and intracranial haemorrhage (ICH).

    Methods

    This was a preplanned meta-analysis of individual patient data from nine randomised clinical trials of intravenous alteplase for AIS. The primary efficacy measure was the proportion of patients who achieved a 3–6 month good outcome per modified Rankin Scale score 0–1. Secondary outcomes …

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    Footnotes

    • Competing interests SL served as expert consultant for Boehringer Ingelheim.

    • Provenance and peer review Commissioned; internally peer reviewed.