Alteplase Significantly Improves Stroke Outcomes

Regardless of age or stroke severity, alteplase significantly improves the odds of a better outcome when delivered within 4.5 hours of stroke onset. The sooner the treatment is started, the bigger the proportional benefits.

In a meta-analysis of 6756 patients in 9 randomized trials comparing alteplase with placebo, the factors that affect good stroke outcome were assessed. Good stroke outcome was measured as no significant disability 3-6 months post-stroke.
_____________________________________________________________________________________________________________________________________________________________________

RELATED CONTENT
Thrombolytics in Acute Pulmonary Embolism
ST-Segment Elevation Myocardial Infarction
_____________________________________________________________________________________________________________________________________________________________________

Researchers noted that treatment with alteplase within 3 hours resulted in a good outcome in 32.9%. Further, 35.3% treated between 3-4.5 hours and 32.6% treated after 4.5 hours had a good outcome.

Proportional treatment benefits were similar regardless of age or stroke severity.

Note: Alteplase significantly increased the odds of symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days. The higher early mortality rate was insignificant after 90 days.

Despite a 2.7% average absolute increased risk of early death from intracranial hemorrhage with alteplase treatment, within 3 to 6 months, patients treated within 3 hours had a 10% higher likelihood of disability-free survival. Patients treated between 3 and 4.5 hours reported a 5% increase in survival.

Reference:

Emberson J, Lees K, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomized trials. Lancet. 2014 Aug 6 [epub ahead of print] doi: 10.1016/S0140-6736(14)60584-5