Thrombolytic treatment of acute ischemic stroke.
Intravenous recombinant tissue-type plasminogen activator is approved by the US Food and Drug Administration for treating acute ischemic stroke within 3 hours of onset of symptoms. Initiation of thrombolysis within 90 minutes of onset of symptoms is a treatment goal supported by current studies. Postmarketing data suggest that the risk of intracranial hemorrhage may be unacceptably high when recombinant tissue-type plasminogen activator is given to patients who would not have been eligible for enrollment in the pivotal phase 3 clinical trials. Further studies of local intra-arterial thrombolysis and improved selection of patients with advanced brain imaging are expected in the future, but the emphasis at present should be on rapid identification, evaluation, and treatment of appropriate patients with intravenous therapy.
Meschia
James F
JF
Department of Neurology, Mayo Clinic, Jacksonville, FL 32224, USA. meschia.james@mayo.edu
Miller
David A
DA
Brott
Thomas G
TG
D000208:Acute Disease; D002545:Brain Ischemia / Q000150:complications*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D020300:Intracranial Hemorrhages / Q000209:etiology; D015337:Multicenter Studies as Topic; D010960:Plasminogen Activators / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D015912:Thrombolytic Therapy / Q000379:methods / Q000639:trends; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed
D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator