CHAPTER 55 TIMING OF tPA IN ACUTE ISCHEMIC STROKE

Association of Outcome With Early Stroke Treatment: Pooled Analysis of ATLANTIS, ECASS, and NINDS rt-PA Stroke Trials

Hacke W, Donnan G, Fieschi C, et al. Lancet. 2004;363:768–774

BACKGROUND

Ischemic stroke is the one of the leading causes of death in the US, and a disease that has only one acute treatment that has ever been FDA approved. The landmark study (National Institute of Neurological Disorders and Stroke [NINDS]) to establish the efficacy of IV tPA only established benefit for patients treated within 3 hours of stroke onset. Unfortunately few patients reach the ED with enough time for treatment in this time window. At the time of this study, there was conflicting evidence to support treatment with IV tPA for all strokes beyond 3 hours, and no definitive study exploring the relationship between the time to treatment and the efficacy of tPA.

OBJECTIVES

To determine whether the time between symptom onset and treatment with IV tPA is a predictor of therapeutic benefit, and to further clarify the appropriate cut off for tPA treatment.

METHODS

Meta-analysis of six large, multicenter, randomized controlled trials conducted in the United States, Europe, and North America.

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