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Updated: Apr 26, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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Thrombolysis for acute ischaemic stroke.
Joanna M Wardlaw1, Veronica Murray, Eivind Berge
1Centre for Clinical Brain Sciences, University of Edinburgh, The Chancellor's Building, 49 Little France Crescent, Edinburgh, UK, EH16 4SB.
The Cochrane Database of Systematic Reviews
|July 30, 2014
Summary
Thrombolytic therapy for acute ischemic stroke significantly reduces death or dependency, especially when administered within three hours. However, it increases the risk of bleeding and early death, necessitating further research for optimal use.
Area of Science:
- Neurology
- Pharmacology
- Clinical Trials
Background:
- Most strokes result from arterial blockages in the brain, treatable with thrombolytic drugs to restore blood flow and improve recovery.
- Thrombolytic drugs, like recombinant tissue plasminogen activator (rt-PA), are used within specific time windows but carry risks of fatal brain hemorrhage.
- Recent data updates provide more comprehensive insights into thrombolytic therapy's efficacy and safety since 2009.
Purpose of the Study:
- To evaluate the effectiveness and safety of thrombolytic therapy for acute ischemic stroke.
- To determine optimal circumstances and patient populations for thrombolytic treatment.
Main Methods:
- Systematic review and meta-analysis of 27 randomized controlled trials involving 10,187 participants.
- Searched multiple databases (Cochrane Stroke Group, MEDLINE, EMBASE) up to November 2013.
- Included trials of various thrombolytic agents (urokinase, streptokinase, rt-PA) administered intravenously or intra-arterially.
Main Results:
- Thrombolytic therapy up to six hours post-stroke reduced death or dependency (OR 0.85).
- Treatment within three hours showed greater benefit (OR 0.66) with no increase in death.
- Increased risk of symptomatic intracranial hemorrhage (OR 3.75) and early death (OR 1.69) observed.
- Intravenous rt-PA demonstrated significant benefits, particularly within three hours.
- Older adults (over 80) benefited equally, especially when treated early.
Conclusions:
- Thrombolytic therapy up to six hours post-stroke improves outcomes but increases hemorrhage risk.
- Early treatment (within three hours) offers substantial benefits.
- Further research is needed to optimize treatment windows, patient selection, and reduce adverse events like intracranial hemorrhage.
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