title: Efficacy of cerebral thrombolysis in an extended 'time window'.
abstract: OBJECTIVE
  Cerebral systemic thrombolysis (i.v. thrombolysis) with tissue-type plasminogen activator (rt-PA) is the only proven medical therapy for ischaemic stroke. The use of i.v. thrombolysis up to 4·5 h from stroke onset was approved in certain countries in 2008, but its safety and efficacy have not been fully determined to date.
  
  
  OBJECTIVE
  To assess the long-term outcome and complication rate of i.v. thrombolysis performed in the extended 'time window'.
  
  
  METHODS
  The study included 403 ischaemic stroke patients consecutively treated with i.v. thrombolysis from 2006 to 2012 at three comprehensive stroke centres in Poland. The long-term outcome and the haemorrhagic complications' (HC) rate were compared between subgroups of patients treated within 3 vs. 3-4·5 h from stroke onset.
  
  
  CONCLUSIONS
  About 132 (32·75%) patients were treated between 3 and 4·5 h from stroke onset. Neurological deficits tended to be more severe in patients treated ≤3 than in those treated 3-4·5 h (National Institutes of Health Stroke Scale, NIHSS 12 vs.10 points; P = 0·053); however, the ratio of patients with a favourable outcome (mRS 0-2 points) and mortality did not differ between the two groups (53·9 vs. 58·3, P = 0·39 and 17·7 vs. 21·2, P = 0·39, respectively). The rate of HC also did not differ between the two groups (18·8% vs. 15·1%, P = 0·46).
  
  
  CONCLUSIONS
  The efficacy of i.v. thrombolysis routinely performed in an extended 'time window' is not reduced when compared to procedures performed within 3 h from symptom onset.
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Sobolewski
authors.affiliation: Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: G
authors.initials: G
authors.lastname: Kozera
authors.affiliation: Department of Neurology and Cerebrovascular Disorders, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: R
authors.initials: R
authors.lastname: Kaźmierski
authors.affiliation: Department of Neurochemistry and Neuropathology, Poznań University of Medical Sciences, Poznań, Poland.
authors.forename: S
authors.initials: S
authors.lastname: Michalak
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Szczuchniak
authors.affiliation: Department of Neurology, Medical University of Gdańsk, Gdańsk, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Nyka
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D008297:Male; D011044:Poland; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: acute ischaemic stroke; extended time window; i.v. thrombolysis