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Related Experiment Videos

Thrombolysis.

K R Lees1

  • 1University Department of Medicine and Therapeutics, Gardiner Institute, Western Infirmary, Glasgow, UK.

British Medical Bulletin
|November 25, 2000
PubMed
Summary
This summary is machine-generated.

Alteplase shows improved outcomes for acute stroke patients treated within 3 hours, unlike streptokinase which carries higher risks. Further research is needed to optimize thrombolytic therapy and patient selection for stroke treatment.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Streptokinase (SK) and alteplase are key thrombolytic drugs for stroke, with differing trial outcomes.
  • SK trials were halted early due to increased hemorrhage and mortality risks without net benefit.
  • Alteplase trials demonstrated more encouraging results, suggesting functional recovery benefits.

Purpose of the Study:

  • To evaluate the efficacy and safety of thrombolytic agents, specifically streptokinase and alteplase, in acute stroke treatment.
  • To compare the benefits and risks associated with different thrombolytic drugs and treatment time windows.
  • To identify optimal patient selection and management protocols for thrombolytic therapy in stroke.

Main Methods:

  • Review and meta-analysis of large clinical trials involving streptokinase and alteplase in acute stroke.

Related Experiment Videos

  • Analysis of patient outcomes, including functional recovery, mortality, and cerebral hemorrhage rates.
  • Examination of treatment timing, dosage, and concomitant medications' impact on thrombolytic efficacy.

    • Main Results:

    • Streptokinase showed significant excess mortality (11.7%) and cerebral hemorrhage (10.7%) with minimal functional recovery (0.6%).
    • Alteplase demonstrated improved functional recovery (7.6%) with lower excess mortality (1.1%) and hemorrhage (8%).
    • Treatment with alteplase within 3 hours yielded the best outcomes (NNT 10.7) with no excess mortality, while later treatment (3-6 hours) had reduced efficacy and increased mortality.

    Conclusions:

    • Alteplase is a more effective and safer thrombolytic agent for acute stroke when administered within 3 hours.
    • Early fibrinogen depletion with ancrod may also be beneficial if initiated within 3 hours.
    • Careful patient selection, exclusion of hemorrhage/infarction, and trained assessment are crucial due to risks like fatal hemorrhagic conversion.