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Updated: Feb 27, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
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Intravenous thrombolysis for acute ischemic stroke: a bridge between two centuries
Georgios Tsivgoulis1,2, Odysseas Kargiotis3, Andrei V Alexandrov2
1a Second Department of Neurology , National & Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital , Athens , Greece.
Expert Review of Neurotherapeutics
|June 24, 2017
Summary
Intravenous thrombolysis (IVT) with tissue-plasminogen activator (tPA) is expanding to new patient groups for acute ischemic stroke. Expanded indications and novel strategies improve safe and timely treatment, even with newer anticoagulants.
Area of Science:
- Neurology
- Emergency Medicine
- Cardiovascular Research
Background:
- Intravenous tissue-plasminogen activator (tPA) is the primary systemic reperfusion therapy for acute ischemic stroke.
- Over 20 years of real-world data have prompted a re-evaluation of initial contraindications for intravenous thrombolysis (IVT).
Purpose of the Study:
- To review expanded indications for safe and timely tPA administration in acute ischemic stroke.
- To discuss novel patient assessment strategies and emerging treatment paradigms.
Main Methods:
- Narrative review of current literature and clinical practice.
- Analysis of expanded IVT indications and novel treatment approaches.
- Discussion of challenges including non-vitamin K antagonist oral anticoagulants (NOACs) and mobile stroke units (MSUs).
Main Results:
- Recent evidence supports expanded use of IVT beyond traditional contraindications.
- Mobile stroke units (MSUs) show potential to reduce onset-to-needle times and increase treatment rates.
- Penumbral imaging may extend the IVT time window for select patients, including wake-up strokes.
Conclusions:
- IVT is increasingly applicable in complex acute ischemic stroke scenarios, including patients on NOACs and those with large vessel occlusion (LVO).
- Emerging strategies like MSUs and advanced imaging hold promise for optimizing IVT delivery and expanding treatment eligibility.
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