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Related Experiment Video

Updated: Feb 27, 2026

Prehospital Thrombolysis: A Manual from Berlin

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

Controversies in Thrombolysis.

Peter A G Sandercock¹, Stefano Ricci²

¹Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Little France Crescent, Edinburgh, EH16 4SB, UK. peter.sandercock@ed.ac.uk.

Current Neurology and Neuroscience Reports

|July 2, 2017

Summary

Intravenous thrombolysis with alteplase improves long-term outcomes for stroke patients within 4.5 hours, despite a small risk of hemorrhage. Further research is needed for extended time windows and optimal patient selection.

Keywords:

Alteplase Functional outcome Imaging Intracerebral haemorrhage Ischaemic stroke Thrombolytic therapy

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Last Updated: Feb 27, 2026

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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia

Published on: August 18, 2015

Area of Science:

Neurology
Cardiovascular Medicine
Pharmacology

Background:

Stroke remains a leading cause of disability worldwide.
Intravenous thrombolysis is a critical treatment for acute ischemic stroke.
Alteplase is the primary thrombolytic agent used in clinical practice.

Purpose of the Study:

To review current evidence on intravenous thrombolysis for stroke.
To identify remaining uncertainties in alteplase treatment protocols.
To evaluate the efficacy and safety of alteplase in different patient populations and time windows.

Main Methods:

Analysis of data from major clinical trials, including IST-3 and ENCHANTED.
Review of individual patient data analyses from alteplase trials.
Examination of evidence regarding standard and lower-dose alteplase regimens.

Main Results:

Adult patients treated with 0.9 mg/kg alteplase within 4.5 hours show improved long-term functional outcomes, with a ~2% risk of fatal intracerebral hemorrhage.
Lower-dose alteplase (0.6 mg/kg) reduces hemorrhage risk but its non-inferiority for functional outcomes is not established.
Evidence for treating patients beyond 4.5 hours or with unknown onset times is limited, requiring further investigation.

Conclusions:

Standard-dose alteplase within 4.5 hours is beneficial for most stroke patients.
Optimal dosing and patient selection criteria for extended time windows require further research.
Continued investigation into imaging methods and eligibility criteria is essential for refining thrombolysis protocols.