Abstract
Stroke is a leading cause of death and disability worldwide, with few effective acute treatments. For patients with ischaemic stroke who present promptly to a properly equipped hospital and receive intravenous alteplase within 4·5 h, chance of regaining excellent functional outcome is greatly increased. 1 Lees KR Bluhmki E von Kummer R et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet. 2010; 375: 1695-1703 Summary Full Text Full Text PDF PubMed Scopus (1598) Google Scholar The treatment effect decays rapidly with time, and patients with larger clot burden or more severe strokes often do not respond to alteplase. Many attempts have been made to determine whether alternative drugs or devices might be more effective than alteplase, but breaking up arterial clots has proven hard to do. Alteplase versus tenecteplase for thrombolysis after ischaemic stroke (ATTEST): a phase 2, randomised, open-label, blinded endpoint studyNeurological and radiological outcomes did not differ between the tenecteplase and alteplase groups. Evaluation of tenecteplase in larger trials of patients with acute stroke seems warranted. Full-Text PDF
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