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Prehospital Thrombolysis: A Manual from Berlin

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Published on: November 26, 2013

Recombinant tissue plasminogen activator for acute ischemic stroke.

Amira R Al-Buhairi¹, Mohammed M Jan

¹Department of Internal Medicine, King Khalid National Guard Hospital, PO Box 9515, Jeddah 21423, Kingdom of Saudi Arabia. Tel. +966 (2) 6240000 ext. 2066. Fax. +966 (2) 6247444.

Neurosciences (Riyadh, Saudi Arabia)

|August 28, 2013

Summary

Recombinant tissue plasminogen activator is an effective treatment for acute ischemic stroke, but less than 5% of patients receive it. This review critically examines if it should be the first-line therapy for stroke patients.

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Area of Science:

Neurology
Cardiovascular Medicine
Emergency Medicine

Background:

Stroke is a major cause of death and disability worldwide, with 750,000 cases annually in the US.
The risk of stroke increases significantly after age 55.
Cerebral angiography reveals arterial occlusion in 70-80% of acute stroke cases.

Purpose of the Study:

To critically review the efficacy of recombinant tissue plasminogen activator (rt-PA) as a first-line treatment for acute ischemic stroke.
To summarize and analyze the results of major rt-PA clinical trials.

Main Methods:

Literature review of major clinical trials involving rt-PA for acute ischemic stroke.
Critical analysis of rt-PA trial data regarding safety and effectiveness.
Evaluation of rt-PA's role in recanalization and recovery of ischemic brain tissue.

Main Results:

Recombinant tissue plasminogen activator (rt-PA) was approved in 1996 as an effective intravenous treatment for acute ischemic stroke, particularly within 3 hours of symptom onset.
Despite its proven efficacy, less than 5% of eligible stroke patients currently receive rt-PA.
Recanalization of occluded cerebral arteries with rt-PA can aid in the recovery of ischemic tissue and reduce neurological deficits.

Conclusions:

The review critically assesses the evidence for recombinant tissue plasminogen activator (rt-PA) as a primary treatment for acute ischemic stroke.
The low uptake of rt-PA highlights a gap between established treatment guidelines and clinical practice.
Further analysis of rt-PA trials is needed to determine its optimal role as a first-line therapy in stroke management.