Optimal timing of thrombolytic therapy in acute ischaemic stroke.
The clinical benefit of thrombolytic therapy for patients experiencing acute cerebral ischaemia has been demonstrated by both clinical trials and phase IV studies. However, such treatments must be initiated in a rapid manner, with treating physicians adhering to strict protocols designed to minimise delays and maximise safety. The efficacy of intravenous drug administration has been established with alteplase (recombinant tissue plasminogen activator; tPA) and ancrod, but only if these drugs can be administered within 3 hours of symptom onset. The use of alteplase beyond this timeframe, or outside of established protocols, may be hazardous. The use of alternative intravenous thrombolytic agents, such as streptokinase, also appears hazardous. Intra-arterial delivery of thrombolytic drugs such as pro-urokinase may extend clinical benefit to the 6-hour time frame.
Madden
Ken
K
Marshfield Clinic, Marshfield, Wisconsin, USA. maddenk@mfldclin.edu
D000721:Ancrod / Q000009:adverse effects / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007261:Infusions, Intra-Arterial; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use; D013300:Streptokinase / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D013300:Streptokinase; D000721:Ancrod; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator