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Recombinant tissue plasminogen activator (t-PA) is FDA-approved for the treatment of acute ischemic stroke within 3 hours after symptom onset. A recent randomized, controlled trial (ECASS 3) demonstrated that intravenous t-PA is safe and effective in patients treated between 3.0 and 4.5 hours after symptom onset (N Engl J Med 2008; 359:1317). Primarily on the basis of this finding, the American Heart Association/American Stroke Association has now issued revised treatment guidelines for acute ischemic stroke that recommend t-PA use up to 4.5 hours after symptom onset.
The guideline authors note that patients eligible for treatment within 3 hours should still be treated according to the AHA/ASA 2007 guidelines. For patients treated between 3.…