Alteplase Still Safe Treatment Up to 4.5 Hours

No differences observed in stroke patients treated within three hours, or between three and 4.5 hours

MONDAY, Sept. 15 (HealthDay News) -- Although intravenous alteplase has been approved for use in stroke patients within three hours of onset, it can be safely and effectively used up to 4.5 hours after onset, according to the results of a study published online Sept. 15 in The Lancet.

Nils Wahlgren, M.D., of the Karolinska Institute in Stockholm, Sweden, and colleagues analyzed data on 12,529 patients who presented with acute ischemic stroke, of whom 11,865 were treated with 0.9 mg/kg of intravenous alteplase within three hours of onset, and 664 received it between three and 4.5 hours after onset.

In the later treatment cohort, treatment was initiated a median 195 minutes after onset of symptoms, versus 140 minutes for those treated within three hours. The patients in the later treatment group were a median three years younger and had less severe strokes than those in the three-hour cohort, the researchers note. Outcomes, including rate of symptomatic intracerebral hemorrhage, mortality and independence were similar for both groups, the investigators found.

"Alteplase remains safe when given with short treatment delays beyond three hours," the authors write. "However, this finding should not slow efforts to facilitate rapid treatment, since the time-dependent benefit from thrombolysis seen in the analysis from pooled data from randomized controlled trials requires that systems be optimized for the earliest possible delivery of alteplase."

Boehringer-Ingelheim provided funding for the study, and several co-authors disclosed financial ties to it and other pharmaceutical companies.

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