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Alteplase (rt-PA) [39] is the current drug of choice for thrombolysis of acute ischemic stroke. The goal is to administer it within 3 hours of symptom onset and within 1 hour of ED arrival, for eligible patients. Data from the ECASS III study have expanded the thrombolytic window to 4.5 hours, but this remains controversial. Compared to placebo, rt-PA, when administered to eligible patients within 3 hours of symptom onset, resulted in more favorable outcomes. Improved outcomes were reported in 31-50% of those treated with rt-PA, compared to 20-38% of those given placebo. These improvements in outcome remained 1-year-out after stroke.
Further data from several studies showed that the most improvement occurred in those patients treated with rt-PA within 90 minutes of stroke onset.[42] | | | | | | |
