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According to current practice standards, fibrinolytic therapy is indicated within 3 hours of the onset of symptoms for patients with ischemic stroke. The need for timeliness of such treatment has been emphasized; however, some have questioned whether the 3-hour treatment window could be extended.
The European Cooperative Acute Stroke Study (ECASS) III was a manufacturer-sponsored and -administered, double-blind, placebo-controlled trial of the efficacy of alteplase in patients with acute stroke symptoms persisting for 3.0 to 4.5 hours. The primary endpoint was disability at day 90 as assessed by the modified Rankin scale, classifying outcomes as favorable (no symptoms or symptoms without disability) or unfavorable (slight disability or worse…