Intravenous alteplase for acute ischaemic stroke.
Thrombolysis with intravenous alteplase is the only validated and approved treatment for acute ischaemic stroke. It is currently licensed for use within 3 h of stroke onset. This treatment improves functional outcome without increasing mortality, although it can initially cause a devastating intracerebral haemorrhage. Risk factors for this complication have been identified and postmarketing studies have shown an acceptable safety profile when the guidelines for drug prescription and administration are rigorously applied. Intravenous alteplase is weakly effective in recanalising major intracranial artery occlusions and more potent strategies of reperfusion are needed. Ongoing clinical trials are evaluating alteplase combined with transcranial ultrasound and intravenous microbubbles, alteplase at reduced doses combined with intravenous glycoprotein IIb/IIIa inhibitors and intravenous alteplase at a reduced dose followed by intra-arterial recanalisation.
Larrue
Vincent
V
Service de Neurologie Vasculaire, Hôpital Rangueil, 31059 Toulouse, France. larrue.v@chu-toulouse.fr
D002545:Brain Ischemia / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D004359:Drug Therapy, Combination; D006801:Humans; D007262:Infusions, Intravenous; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000493:pharmacokinetics
D010959:Tissue Plasminogen Activator