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Updated: May 25, 2026

Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Early experience with community implementation of thrombolysis three to 4.5 hours after acute ischemic stroke
Mathew Alias1, Ilene Staff, Louise D McCullough
1The Department of Neurology, The University of Connecticut and The Stroke Center at Hartford Hospital, Farmington, USA. malias@resident.uchc.edu
Background:
The therapeutic time window for IV thrombolytic treatment was recently extended at Hartford Hospital to 4.5-hours. We assessed the safety and efficacy of delayed thrombolysis.
Methods:
All patients given IV tPA for acute ischemic stroke (AIS) since 2006 were assessed. The risk of sICH in patients given tPA < or = three-hours vs > three-hours from onset of symptoms and acute change in NIH Stoke Scale (NIHSS) was evaluated.
Results:
sICH rates were higher in patients who received IVtPA > three-hours (7.7%, n=39) compared to patients treated in the zero to three-hour window (4.0%, n=251; P = 0.30) but this was not statistically significant.
Conclusions:
Administration of tPA in the three to 4.5-hour window appears to be a safe alternative for patients presenting after three-hours. Caution is advised however, as sICH rates trended higher in patients in the three to 4.5-hour cohort.
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