No Evidence for Selective Use of Alteplase Based on Age or Stroke Severity

Stroke remains a leading cause of disability, and little evidence suggests that therapies other than intravenous thrombolysis with alteplase improve outcomes after acute ischemic stroke. However, questions remain about the effectiveness of alteplase in different patient subgroups, particularly older patients and those with severe or mild strokes. To address these uncertainties, investigators have performed an individual patient-level meta-analysis of randomized clinical trials of alteplase for acute ischemic stroke.

Among 6756 patients in nine trials comparing alteplase to placebo or open control, treatment with alteplase within 3 hours after stroke increased the absolute chance of a good neurological outcome (defined as a score of 0 or 1 on…