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Intravenous alteplase is effective therapy for acute ischemic stroke when administered within 3 hours of symptom onset. However, the drug is severely underused, mostly due to fears about symptomatic intracranial hemorrhage (SICH).
In a prospective, observational, 285-center European study of intravenous alteplase, used within 3 hours of symptom onset, researchers compared the drug’s safety in 6483 ischemic-stroke patients (age ≤80, NIH Stroke Scale [NIHSS] score <25) with its previously documented safety in similar, randomized-trial subjects. Of the observational cohort, 23% were treated at centers that had little previous experience with stroke fibrinolysis.
The 24-hour rate of SICH, defined as parenchymal hematoma type 2 on CT scan at 22 to…