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Early thrombolysis with recombinant tissue plasminogen activator (rt-PA) improves outcomes after ischemic stroke. But how early is early enough? And is there a point after which rt-PA causes more harm than good? To find the answers, authors of a new meta-analysis combined data from two recent placebo-controlled trials and six older ones.
In total, 3670 patients with ischemic stroke were randomized to receive the rt-PA alteplase or placebo infused intravenously over 1 hour. Each patient had a clearly defined time of stroke onset; patients with hemorrhagic stroke or elevated risk for bleeding were systematically excluded. Outcomes were evaluated for different ranges of onset-to-treatment times (OTTs) between 0 and 6 hours. A favorable outcome …