title: The yield of expanding the therapeutic time window for tPA.
abstract: OBJECTIVE
  Intravenous thrombolysis with recombinant tissue plasminogen activator (tPA) for acute ischemic stroke has been proved to be effective when given within 3 h of onset of stroke symptoms. Partly due to this time limit, less than 10% of stroke patients are treated with tPA. This study assessed the potential for increased tPA utilization with a theoretical time limit of 6 h.
  
  
  METHODS
  A total of 117 patients admitted with a diagnosis of acute cerebrovascular disease were prospectively registered over a 3-month period, with emphasis on timing and criteria for tPA treatment.
  
  
  RESULTS
  Eighty-eight of 117 patients (75%) had an acute ischemic stroke. Of these, 23% arrived within 3 h, 8% within 3-6 h, and 69% later than 6 h after symptom onset. Of the seven patients in the 3-6 h group, only one had time delay as the only contraindication to tPA.
  
  
  CONCLUSIONS
  This study suggests that reducing patient delay, rather than increasing the time limit for thrombolytic treatment, may increase the frequency of tPA utilization. Changing time limits for thrombolysis may reduce time delay from stroke onset to arrival in hospital due to more rapid handling of patients by the emergency medical services.
authors.affiliation: Section for Neurology, Institute of Clinical Medicine, University of Bergen, Bergen, Norway. jone.furlund.owe@helse-bergen.no
authors.forename: J F
authors.initials: JF
authors.lastname: Owe
authors.forename: P S
authors.initials: PS
authors.lastname: Sanaker
authors.forename: H
authors.initials: H
authors.lastname: Naess
authors.forename: L
authors.initials: L
authors.lastname: Thomassen
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D000075202:Contraindications; D004638:Emergency Treatment / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014187:Transportation of Patients / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator