ASA: Alteplase Ups Outcomes at 4.5 to 24 Hours After Symptom Onset in Acute Ischemic Stroke

TUESDAY, Feb. 18, 2025 (HealthDay News) — For patients with acute ischemic stroke (AIS) whose symptoms began 4.5 to 24 hours earlier, alteplase is associated with a higher percentage of patients achieving a score of 0 or 1 on the modified Rankin scale at 90 days, according to a study presented at the annual American Stroke Association International Stroke Conference, held from Feb. 5 to 7 in Los Angeles.

Min Lou, M.D., Ph.D., from the Second Affiliated Hospital of Zhejiang University School of Medicine in China, and colleagues conducted a prospective, randomized trial at 26 stroke centers in China involving patients with clinical signs of AIS within 4.5 and 24 hours and salvageable tissue on perfusion imaging. Patients were randomly assigned to receive intravenous alteplase or standard medical treatment (186 participants in both groups). The primary outcome was a score of 0 or 1 on the modified Rankin scale at 90 days.

Less than 3 percent of patients underwent endovascular thrombectomy (three and seven in the alteplase and standard medical treatment groups, respectively). The researchers found that the percentage of patients achieving a primary outcome was 40.3 and 26.3 percent in the alteplase and standard medical treatment groups, respectively (relative rate, 1.40; 95 percent confidence interval, 1.05 to 1.87). Mortality at 90 days was 10.8 percent with both alteplase and standard medical treatment, while the incidence of symptomatic intracerebral hemorrhage was 3.8 and 0.5 percent, respectively, within 36 hours after randomization.

“We believe these findings mean more people may return to normal or near-normal lives after a stroke, even if they receive treatment later than originally thought beneficial,” Lou said in a statement.

Press Release

More Information