The results of three international stroke trials published recently in The Lancet1 confirm that the quicker rt-PA (Actilyse, recombinant tissue plasminogen activator) is given to stroke patients, the greater the benefit.
A pooled analysis of the NINDS, ECASS and ATLANTIS stroke trials confirmed that quicker administration of rt-PA improved the odds ratio of having a favourable outcome by 2.8 for 0-90 minutes, and 1.5 for 90-180 minutes. The analysis clearly shows, that, although thrombolysis may be beneficial up to 4 1/2 hours after onset of stroke, it is of utmost importance that the treatment is started as early as possible. Outcome was measured by methods of stroke assessment, including the National Institutes of Health Stroke Scale (NIHSS), Barthel index and modified Rankin scores in acute ischaemic stroke patients
The analysis utilised data from six large randomized trials of intravenous rt-PA administered to 2775 acute ischaemic stroke patients, treated at over 300 hospitals from 18 countries.
"This has important implications for the timing of thrombolytic therapy as it is patients with more severe strokes who have the most to gain from early treatment" commented Professor Werner Hacke, Head of the Department of Neurology at the University Heidelberg, Germany and Chair of ECASS II. "However, it is of paramount importance to treat all patients without delay. This means that acute stroke teams should now focus all of their efforts on reducing the time from arrival at the hospital, to the start of rt-PA treatment, in order to improve all patients' odds of a favourable recovery".
The use of thrombolytic therapy is the most recent advancement in the management of acute ischaemic stroke, a condition for which treatment has previously been limited to supportive and rehabilitative care.