Cochrane Summaries

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Thrombolysis for acute ischaemic stroke

Wardlaw JM, Murray V, Berge E, del Zoppo GJ
Published Online: 
7 October 2009

Thrombolytic therapy is one of the most promising treatments for acute ischaemic stroke. The majority of strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with clot dissolving (thrombolytic) drugs can restore blood flow before major brain damage has occurred. Successful treatment could mean the patient is more likely to make a good recovery from their stroke. Thrombolytic drugs can also, however, cause serious bleeding in the brain, which can be fatal. Thrombolytic therapy has now been evaluated in several randomised trials in acute ischaemic stroke. The thrombolytic drug alteplase (rt-PA) has been licensed for use within three hours of stroke in the USA, Canada, and most European countries but only few patients receive the treatment. This review of 26 trials involving 7152 patients confirmed that thrombolytic treatment can reduce the risk of disability, despite the bleeding risks. However, there was not enough evidence to answer several questions. How big is the overall benefit? What is the latest time window in which the treatment is still beneficial? Which grades of stroke severity and which types of stroke, as judged clinically and on brain imaging, are more likely to respond favourably to treatment? Should patients aged over 80 years receive thrombolysis? Which types of patients are most likely to be harmed by, and which to benefit from, treatment (e.g. with or without other major medical conditions like cardiac arrhythmias, diabetes, hypertension, or other disorders and concomitant medication)? To answer these questions reliably, and in particular to be able to tailor treatment to the individual patient, more data are needed from new randomised controlled trials.