Thrombolysis in acute ischaemic stroke: time for a rethink?

  title={Thrombolysis in acute ischaemic stroke: time for a rethink?},
  author={Brian S. Alper and Meghan Malone-Moses and James S. McLellan and Kameshwar Prasad and Eric W. Manheimer},
  journal={BMJ : British Medical Journal},
As the UK regulator reviews alteplase in ischaemic stroke, Brian Alper and colleagues interpret the evidence to suggest increased mortality with uncertain benefit for its use beyond three hours 
Intravenous thrombolysis for acute ischaemic stroke in the elderly: data from the Baden‐Wuerttemberg stroke registry
In Europe intravenous thrombolysis (IVT) for ischaemic stroke is still not approved for patients aged >80 years. However, elderly patients are frequently treated based on individual decision making.
Review article: Why is there still a debate regarding the safety and efficacy of intravenous thrombolysis in the management of presumed acute ischaemic stroke? A systematic review and meta‐analysis
The objective of the present study is to independently and systematically assess the harms and benefits of intravenous thrombolysis for patients with presumed acute schaemic stroke.
Cochrane reviewers’ response to Alper and colleagues’ analysis of thrombolysis in acute ischaemic stroke
The validity of the Cochrane review of thrombolytic treatment in stroke and the conclusion that treatment improves outcome if given up to 4.5 hours after stroke is questioned.
Delivering thrombectomy for acute stroke using cardiology services
Why should the location of an acutely occluded artery affect who gets treated?
Thrombolytic Treatment for Ischaemic Stroke: Could the Crisis of Confidence Have Been Avoided by Better Analysis of Trial Data?
A ‘three-way prognosis-based outcome’ analysis of existing and future trials could greatly increase the amount of relevant evidence to guide clinical decisions for individual patients across the range of stroke severity.
Authors’ reply to Wardlaw and Berge
Wardlaw and Berge note the use of data from all thrombolytic trials and alteplase trials, and that distinguishing between these conclusions could be a source of confusion.1 Either way, we question
Thrombolysis with alteplase 3–4.5 hours after acute ischaemic stroke: trial reanalysis adjusted for baseline imbalances
Reanalysis of the ECASS III trial data with multiple approaches adjusting for baseline imbalances does not support any significant benefits and continues to support harms for the use of alteplase 3–4.5 hours after stroke onset.
Ethical issues in stroke thrombolysis revisited
Whether ethical issues raised in 1997 on intravenous thrombolysis in acute ischaemic stroke have been resolved is analyzed.


Consensus Statement on the Use of Intravenous Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke by the Chinese Stroke Therapy Expert Panel
The last update of the consensus statement on intravenous recombinant tissue plasminogen activator (IV rt‐PA) for acute ischemic stroke (AIS) by the Chinese Stroke Therapy Expert Panel was published
Thrombolytic Therapy in the Treatment of Stroke
In both trials, the frequency of symptomatic haemorrhage was greater in patients treated with alteplase than with placebo and reinforced the importance of careful patient selection.
Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.
As compared with placebo, intravenous alteplase administered between 3 and 4.5 hours after the onset of symptoms significantly improved clinical outcomes in patients with acute ischemic stroke; altePlase was more frequently associated with symptomatic intracranial hemorrhage.
The United Kingdom transient ischaemic attack (UK-TIA) aspirin trial: final results.
The odds of suffering a major stroke, myocardial infarction or vascular death were 15% less in the combined aspirin groups compared with the placebo group which is compatible with the continuing overview of all the similar trials of antiplatelet drugs.
South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: a guideline from the South African Stroke Society (SASS) and the SASS Writing Committee.
The objective was to update the guideline published in 2000, to place the recommendations within the current South African context, and to grade evidence according to the level of scientific rigour.