Earliest Receipt of Alteplase Benefits Stroke Outcomes Most

The longer the delay, the lower the odds of good outcome; little, if any, benefit seen past 4.5 hours
By Beth Gilbert
HealthDay Reporter

FRIDAY, May 14 (HealthDay News) -- The thrombolytic drug alteplase should be given as soon as possible after a stroke, as the odds of a favorable outcome decrease as the time to treatment increases, according to a pooled analysis published online May 15 in The Lancet.

Kennedy R. Lees, of the University of Glasgow in the United Kingdom, and colleagues evaluated pooled data from 3,670 patients in eight trials who had received either alteplase or placebo within 360 minutes of stroke onset.

The researchers found that the likelihood of a favorable three-month outcome increased as the onset to start of treatment decreased, with no benefit from alteplase treatment gained after approximately 270 minutes. For treatment within zero to 90 minutes, 91 to 180 minutes, 181 to 270 minutes, and 271 to 360 minutes, the adjusted odds of a favorable three-month outcome were 2.55, 1.64, 1.34, and 1.22, respectively, in favor of those receiving alteplase; the adjusted odds of mortality were 0.78, 1.13, 1.22, and 1.49, respectively. Large parenchymal hemorrhage occurred in 5.2 percent of patients undergoing treatment with alteplase and 1 percent of patients receiving placebo, with no clear association found with onset to start of treatment.

"Patients with ischaemic stroke selected by clinical symptoms and computed tomography benefit from intravenous alteplase when treated up to 4.5 hours," the authors write. "To increase benefit to a maximum, every effort should be taken to shorten delay in initiation of treatment. Beyond 4.5 hours, risk might outweigh benefit."

Multiple authors received honoraria from Boehringer Ingelheim related to trials included in the pooled analysis. Several authors also disclosed financial ties to other pharmaceutical companies.

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