Alteplase for acute ischemic stroke.
Alteplase, an intravenously administered form of recombinant tissue plasminogen activator (rt-PA), remains the only US FDA-approved thrombolytic treatment for acute ischemic stroke within 3 h of symptom onset. Patients treated with intravenous rt-PA are at least 30% more likely to have minimal or no disability at 3 months compared with placebo. Despite an increased risk of symptomatic intracranial hemorrhage, rt-PA does not increase mortality. The benefit achieved with rt-PA is cost effective and sustained 1 year after treatment. Despite its clear benefit, rt-PA remains underutilized. Although the future of acute ischemic stroke treatment will most likely involve a multi-faceted treatment approach, the primary objective remains to establish recanalization of the involved vessel. For patients with acute ischemic stroke within the first 3 h of symptom onset, rt-PA remains the first step in accomplishing this goal.
Gonzales
Nicole R
NR
University of Texas, Houston Medical School, 6431 Fannin, MSB 7.118, Houston TX 7703, USA. Nicole.R.Gonzales@uth.tmc.edu
Grotta
James C
JC
D002545:Brain Ischemia / Q000188:drug therapy* / Q000401:mortality; D002986:Clinical Trials as Topic; D004305:Dose-Response Relationship, Drug; D004638:Emergency Treatment; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality; D010959:Tissue Plasminogen Activator / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator