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Thrombolysis for acute ischemic stroke within 6 hours improves outcomes, especially when given within 3 hours. Elderly patients and those with severe strokes also benefit from this treatment.

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Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • Acute ischemic stroke is a leading cause of disability.
  • Intravenous thrombolysis is a time-sensitive treatment.
  • Previous trials had restrictive eligibility criteria, particularly for elderly patients.

Purpose of the Study:

  • To evaluate the efficacy and safety of thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) in a broad range of acute ischemic stroke patients.
  • To determine if rt-PA benefits patients not typically included in prior trials, such as those over 80 years old.

Main Methods:

  • The third International Stroke Trial (IST-3) was a large, randomized controlled trial.
  • Recruited 3035 patients with acute ischemic stroke within 6 hours of symptom onset.
  • Included a wide spectrum of patients, with no upper age limit; over half were aged over 80.

Main Results:

  • Despite early risks like intracerebral hemorrhage, thrombolysis within 6 hours did not impact long-term survival but improved functional outcomes.
  • Treatment benefit was most pronounced when administered within 3 hours of stroke onset.
  • Elderly patients and those with severe strokes showed no diminished benefit.

Conclusions:

  • Clinicians should consider thrombolysis for a broader patient population, including the elderly and those with severe strokes.
  • Efforts to increase the proportion of patients treated within the critical 3-hour window should be reinforced.
  • Thrombolysis is not associated with increased mortality in this diverse patient group.