CHAPTER 56 EXPANDED WINDOW FOR tPA IN STROKE: THE ECASS III STUDY

Thrombolysis With Alteplase 3 to 4.5 Hours After Acute Ischemic Stroke

Hacke W, Kaste M, Bluhmki E, et al. N Engl K Med. 2008;359(13):1317–1329

BACKGROUND

In 1995 the NINDS trial showed that patients treated with Alteplase (tPA) within 3 hours of onset of stroke symptoms were 30% more likely to have minimal or no disability at 3 months. International guidelines recommend tPA as first-line treatment for all eligible patients; however, fewer than 2% patients received this intervention, mostly due to delay in presentation to a stroke center. Extending the treatment window became a goal for subsequent research. The ECASS and ECASS II trials investigated the use of tPA up to 6 hours but failed to show efficacy. Some small randomized trials and the pooled analysis in the prior study showed favorable outcomes between 3 and 4.5 hours but clarification of the timing and patient population was needed.

OBJECTIVES

To test the efficacy and safety of tPA between 3 and 4.5 hours after the onset of stroke symptoms.

METHODS

Double-blind, parallel group trial, from 130 centers across 19 European countries.

Participants

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