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Updated: Feb 27, 2026

Prehospital Thrombolysis: A Manual from Berlin
05:52

Prehospital Thrombolysis: A Manual from Berlin

Published on: November 26, 2013

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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
PubMed

Insights

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.

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.
Abstract

Keywords:
AlteplaseFunctional outcomeImagingIntracerebral haemorrhageIschaemic strokeThrombolytic therapy

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