Window for Stroke Treatment Opened to 4.5 Hours

Treatment window for rtPA expanded for some stroke patients but confirmation with further analyses urged
By Jeff Muise
HealthDay Reporter

FRIDAY, May 29 (HealthDay News) -- The clot-busting drug recombinant tissue plasminogen activator (rtPA) can be given to eligible stroke victims as long as 4.5 hours after onset of symptoms, according to a new scientific advisory published online May 28 in Stroke: Journal of the American Heart Association, but the American Heart Association (AHA)/American Stroke Association (ASA) still urge further analyses.

Gregory J. del Zoppo, M.D., chair of the AHA/ASA advisory writing committee, and colleagues based the new rtPA guideline on results from the 2008 European Cooperative Acute Stroke Study-3 (ECASS-3), a multicenter, randomized trial in which some patients were treated successfully with rtPA up to 4.5 hours after stroke onset.

The authors note that eligibility criteria for rtPA treatment within 4.5 hours is similar to three-hour criteria. However, some patients suitable for treatment within three hours should not be treated during the expanded treatment window, including those older than 80, suffering a severe stroke, with a history of stroke and diabetes, or taking oral anticoagulants with an international normalized ratio of 1.7 at most.

"The ECASS-3 trial represents an important advance in the treatment of acute ischemic stroke. The results, which are consistent with the results in this time window from previous studies and pooled analyses of previous trials, provide level B evidence that intravenous rtPA can be given safely to carefully selected patients treated three to 4.5 hours after stroke and that intravenous rtPA given in this time period can improve outcomes after stroke in a selected group of patients," the authors write.

Some members of the writing committee reported financial relationships with the pharmaceutical industry.

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