Alteplase Given Promptly after Stroke Reduces Long-term Disability

More stroke patients could benefit from thrombolytics to break up clots if the treatment was administered as quickly as possible after the first signs of illness, according to a new meta-analysis published Aug. 6 in The Lancet.

When administered within 4 to 5 hours of onset of stroke symptoms, alteplase was shown to markedly improve the changes of a good outcome; its benefits diminish the later it is given.

Jonathan Emberson, PhD, from the Clinical Trial Service Unit at the University of Oxford in the United Kingdom, and colleagues conducted the meta-analysis of individual patient data from all the major trials of alteplase for treatment of ischemic stroke. To date, it is the largest study investigating thrombolytic medication alteplase.

Nine randomized trials involving 6,756 patients (1,729 over age 80) found alteplase treatment significantly increased the odds of a good stroke outcome, that is, no significant disability 3 to 6 months after the stroke. Faster treatment offered the best chance of recovery.

“What this shows is that we are up against the clock when treating ischemic stroke,” Kennedy Lees, study co-author and professor of Cerebrovascular Medicine at the University of Glasgow, UK, said in a statement. “Every minute counts. People need to be identified quickly and systems need to be in place to get them scanned, diagnosed accurately, and then treated within minutes to hours.”

The odds of a good stroke outcome were 75% greater for patients given alteplase within 3 hours of initial stroke symptoms, compared with those who did not receive the medication. For those given alteplase between 3 and 4-and-a-half hours after stroke, there was a 26% increased chance of a good outcome. If alteplase was delayed more than 4-and-a-half hours, there was only a statistically insignificant 15% increased chance of a good recovery.

Although alteplase increased the risk of death from intracranial hemorrhage by approximately 2% within the first few days after stroke, by a few months those treated with alteplase were less likely to be disabled than those who did not receive the treatment, according to Emberson.

The benefits of alteplase were observed in all patient groups studied, included those over age 80 and those with severe strokes, demonstrating that the elderly should be treated with the same urgency as younger patients.

“These results demonstrate that upper age limits in clinical trials can inadvertently lead to the elderly being excluded from an effective treatment,” Richard Linley, study co-author and professor of Geriatric Medicine at the University of Sydney, said in a statement. “These new results tell us that the elderly should be treated with the same urgency as younger patients.”