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Current Neurology and Neuroscience Reports

, 17:60

Topical Collection on Stroke


Purpose of ReviewThe purpose of the review is to examine recent evidence on the effects of intravenous thrombolysis and identify the remaining uncertainties.

Recent FindingsWe review the results of two large trials the third International Stroke Trial IST-3 and The Enhanced Control of Hypertension and Thrombolysis Stroke Study ENCHANTED and the publications from the individual patient data analyses of the trials of alteplase conducted by the Stroke Thrombolysis Trialists Collaboration.

SummaryDespite about a 2% risk of fatal intracerebral haemorrhage, on average, adult patients of all ages treated with 0.9 mg-kg alteplase within 4.5 h will have better long-term functional outcome. The use of a lower dose of alteplase 0.6 mg-kg is associated with a lower risk of haemorrhage but its effect on functional outcome has not been proven to be non-inferior to standard dose therapy. Some clinicians feel confident to treat selected patients who present beyond 4.5 h or have unknown time of onset, but many also agree that the current trials and other research is needed to reliably define the optimum imaging methods and treatment eligibility criteria.

KeywordsIschaemic stroke Thrombolytic therapy Alteplase Intracerebral haemorrhage Functional outcome Imaging This article is part of the Topical Collection on Stroke

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Author: Peter A. G. Sandercock - Stefano Ricci



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