Elsevier

Journal of Vascular Surgery

Volume 54, Issue 3, September 2011, Pages 901-907
Journal of Vascular Surgery

Evidence summary
Thrombolysis for acute ischemic stroke

https://doi.org/10.1016/j.jvs.2011.04.062Get rights and content
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Thrombolysis with intravenous alteplase is the primary therapy for acute ischemic stroke, and is approved in most countries. Early administration improves functional outcome though benefit and risk depend on the time elapsed between stroke onset and initiation of treatment. Randomized controlled trials demonstrated benefit from intravenous thrombolysis when initiated up to 4.5 hours after symptom onset, and pooled analysis of all trials indicates that the sooner that alteplase is given, the greater is the benefit. Treatment carries a risk of bleeding, with symptomatic intracranial hemorrhage (SICH) of around 3%. Initiating treatment after 4.5 hours increases mortality and reverses the risk-benefit balance. Baseline stroke severity, age, diabetes and concomitant stroke are associated with poorer outcome from acute stroke; but secondary analyses and controlled registry data suggest that intravenous alteplase remains effective in most subgroups. Intra-arterial thrombolysis has a less extensive evidence base and is mostly unapproved for acute stroke. Access to thrombolysis remains patchy and involves unacceptable delays: greater awareness of the benefits and time dependency are crucial.

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Competition of interest: Dr Lees has received fees or expenses from Archemix, American Stroke Association, Astellas, Asubio, Bayer, Boehringer Ingelheim, Co-Axia, D-Pharm, EVER, Ferrer, GlaxoSmithKline, infill, Johnson & Johnson, Lundbeck, Merck Sharpe and Dhome, Mitsubishi, Photothera, Quintiles, Sanofi-Aventis, Servier, Solvay, Talecris, and Wyeth. Dr Hajjar has received fees or expenses from Boehringer Ingelheim, D-Pharm, European Stroke Organization, and Lundbeck.

The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a competition of interest.