Treatment With rt-PA Within Six Hours of Stroke Beneficial

Randomized trial, meta-analysis show benefit for wide range of patients with acute ischemic stroke

WEDNESDAY, May 23 (HealthDay News) -- For patients with acute ischemic stroke, treatment with recombinant tissue plasminogen activator (rt-PA) within six hours is associated with improved outcomes, according to two studies published online May 23 in The Lancet to coincide with presentation at the European Stroke Conference, held from May 22 to 25 in Lisbon, Portugal.

Peter Sandercock, D.M., from the University of Edinburgh in the United Kingdom, and colleagues conducted the third International Stroke Trial involving a wide range of patients (3,035) with acute ischemic stroke, enrolled in 156 hospitals in 12 countries. Participants (of whom 53 percent were older than 80 years) were randomly allocated to receive rt-PA within six hours of stroke (1,515 patients) or to control (1,520 patients). At six-months, the researchers observed no significant difference in the percentage of patients alive and independent (37 percent in the rt-PA group versus 35 percent in the control group). A significant shift in Oxford Handicap Scores was seen on ordinal analysis (common odds ratio [OR], 1.27).

In a second study, Joanna M. Wardlaw, M.D., also from the University of Edinburgh, and colleagues conducted an updated systematic review and meta-analysis which included 12 trials involving 7,012 patients given rt-PA within six hours of onset of acute ischemic stroke. The researchers found that rt-PA was associated with significantly increased odds of being alive and independent (modified Rankin scale 0 to 2) at the final follow-up (OR, 1.17). Patients treated within three hours received the greatest benefit (OR, 1.53).

"The data strengthen previous evidence to treat patients as early as possible after acute ischemic stroke, although some patients might benefit up to six hours after stroke," Wardlaw and colleagues conclude.

Several authors from both studies disclosed financial ties to the pharmaceutical industry.

Abstract - Sandercock
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Abstract - Wardlaw
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