Alteplase Remains Safe Up to 4.5 Hours After Acute Stroke

And extending treatment window from three hours up to 4.5 hours not found to delay stroke treatment
By Beth Gilbert
HealthDay Reporter

TUESDAY, July 27 (HealthDay News) -- Extending the treatment window for administration of alteplase from three hours to 4.5 hours in patients who experience an acute ischemic stroke is safe and does not result in delayed treatment of patients, according to a study published online July 27 in The Lancet Neurology.

In a follow-up to the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry (SITS-ISTR) observational study, Niaz Ahmed, M.D., of the Karolinska University Hospital and Karolinska Institutet in Stockholm, Sweden, and colleagues assessed implementation of the extended time window for intravenous alteplase treatment from within three hours to within 4.5 hours after stroke onset. Patients were grouped according to whether they were registered into SITS-ISTR before or after October 2008.

The researchers found that the proportion of patients treated within three to 4.5 hours by the end of 2009 was three times higher than in the first three quarters of 2008 (22 versus 7 percent). The median admission-to-treatment time was 65 minutes for patients registered before and after October 2008. Compared to patients treated within three hours after stroke, patients treated from three to 4.5 hours had higher rates of symptomatic intracerebral hemorrhage and death as well as worse functional outcome at three months, after adjusting for confounding variables, though the researchers found the overall proportion of these outcomes low.

"Alteplase remains safe when given with short treatment delays beyond three hours Nevertheless, our results emphasize that patients should be treated as early as possible after stroke," the authors write.

The study was funded by Boehringer Ingelheim and Ferrer. Several authors disclosed financial ties to these organizations and various other pharmaceutical and/or medical device companies.

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