title: Current perspectives on the use of intravenous recombinant tissue plasminogen activator (tPA) for treatment of acute ischemic stroke.
abstract: In 1995, the NINDS (National Institute of Neurological Disorders and Stroke) tPA (tissue plasminogen activator) Stroke Study Group published the results of a large multicenter clinical trial demonstrating efficacy of intravenous tPA by revealing a 30% relative risk reduction (absolute risk reduction 11%-15%) compared with placebo at 90 days in the likelihood of having minimal or no disability. Since approval in 1996, tPA remains the only drug treatment for acute ischemic stroke approved by the US Food and Drug Administration. Over the years, an abundance of research and clinical data has supported the safe and efficacious use of intravenous tPA in all eligible patients. Despite such supporting data, it remains substantially underutilized. Challenges to the utilization of tPA include narrow eligibility and treatment windows, risk of symptomatic intracerebral hemorrhage, perceived lack of efficacy in certain high-risk subgroups, and a limited pool of neurological and stroke expertise in the community. With recent US census data suggesting annual stroke incidence will more than double by 2050, better education and consensus among both the medical and lay public are necessary to optimize the use of tPA for all eligible stroke patients. Ongoing and future research should continue to improve upon the efficacy of tPA through more rapid stroke diagnosis and treatment, refinement of advanced neuroimaging and stroke biomarkers, and successful demonstration of alternative means of reperfusion.
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Sherita N
authors.initials: SN
authors.lastname: Chapman
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Prachi
authors.initials: P
authors.lastname: Mehndiratta
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Johansen
authors.affiliation: Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
authors.forename: Timothy L
authors.initials: TL
authors.lastname: McMurry
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA ; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnston
authors.affiliation: Department of Neurology, University of Virginia, Charlottesville, VA, USA ; Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Southerland
mesh_terms: D061605:Administration, Intravenous; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D018579:Patient Selection; D011994:Recombinant Proteins / Q000008:administration & dosage; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator
keywords: IV tPA; cerebrovascular accident; cerebrovascular disease; rt-PA; rtPA; t-PA