title: Thrombolytic Therapy in Wake-Up Stroke Patients.
abstract: OBJECTIVE
  The aim of the study is to review existing and ongoing trial data on wake-up stroke (WUS) patients for thrombolytic therapy.
  
  
  METHODS
  A literature search was conducted in PubMed (conception-October 2016) using the terms wake-up stroke, acute ischemic stroke, wake-up thrombolysis, computed tomography imaging in wake-up stroke, and magnetic resonance imaging in wake-up stroke. Ongoing trials were found using the ClinicalTrials.gov website.
  
  
  RESULTS
  The search yielded 61 articles in PubMed and 7 ongoing trials. After removing duplicate/irrelevant articles, 33 articles and relevant references were reviewed; of these, 6 articles and 3 ongoing trials were included. Two retrospective studies evaluating the characteristics between WUS and known-onset stroke were identified; the only significant difference between groups was the ability to receive treatment with tissue plasminogen activator (tPA). One study suggested that perfusion brain imaging may be useful to identify patients that may benefit from tPA. In addition, 3 studies have evaluated WUS treatment; all used different methods to identify potential patients. Two of 3 studies showed that treatment with tPA is associated with better outcomes when controlling for baseline National Institutes of Health Stroke Scale. No difference in safety outcomes was seen between groups for all 3 studies.
  
  
  CONCLUSIONS
  Available data suggest promising strategies to identify WUS patients who may benefit from thrombolysis. Once on-going trials are complete, there may be sufficient information to redefine tPA eligibility for previously excluded patients.
authors.affiliation: *Brigham and Women's Hospital, Boston, MA; †Edward-Elmhurst Healthcare, Naperville, IL; ‡Mercy Hospital St Louis; and §St Louis College of Pharmacy, St Louis, MO.
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Stern
authors.forename: Nicholas
authors.initials: N
authors.lastname: Van Hise
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Urben
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Korobey
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Pitlick
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Crannage
mesh_terms: D000203:Activities of Daily Living; D035843:Biomedical Research / Q000379:methods / Q000639:trends; D019317:Evidence-Based Medicine; D006801:Humans; D059906:Neuroimaging / Q000639:trends; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000639:trends; D014851:Wakefulness