Thrombolysis for Acute Ischemic Stroke

Graeme J. Hankey MD, FRACP, FRCP Section Editor: Recombinant tissue plasminogen activator (rtPA) is licensed for thrombolytic therapy in ischemic stroke if administered within 3 hours of stroke onset in selected patients (to be extended to 4.5 hours in some countries). However, many patients who could benefit from rtPA are not offered it and there is evidence that rtPA could benefit many patients who do not meet current license criteria. Furthermore, the patient characteristics that might assist in stratifying risk and benefit and the latest time at which thrombolysis may be effective remain unknown.The objectives of this study were to assess the safety and efficacy of thrombolytic agents used in acute treatment of ischemic stroke, factors that might influence risk or benefit, and estimate if current data can identify the latest time window for treatment.We used the Cochrane Stroke Group Trials Register, MEDLINE, and EMBASE; contact with trialists, and hand-searching of pertinent journals (all to October 2008).Selection criteria were randomized trials of any thrombolytic agent compared with a control in patients with definite ischemic stroke.Two reviewers applied the inclusion criteria, extracted the data (published and unpublished), and assessed trial quality. We calculated ORs and 95% CIs for all main outcomes using fixed effects methods (additionally by random effects methods where significant between-trial heterogeneity was present), calculated the effect per 1000 patients …