Use of Alteplase Beyond 3 Hours of Ischemic Stroke Onset

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Tissue plasminogen activator, alteplase (Activase) is the U.S. Food and Drug Administration (FDA) approved thrombolytic for acute ischemic stroke and is currently FDA approved for administration up to 3 hr from stroke onset. However, new research suggests there are benefits from alteplase beyond the 3 hr window. Utilizing PubMed, a literature review was conducted between the years of 1998 and 2010 for research including the keywords “alteplase and ischemic stroke,” “thrombolytics and ischemic stroke,” “thrombolysis with alteplase” and “stroke protocol.” New research as well as a statement from the American Heart Association and American Stroke Association, supports extending the administration of alteplase after ischemic stroke onset while continuing to acknowledge the risks alteplase poses to the patient. With the understanding that 4 out of 10 stroke victims arrive after the current 3 hr administration protocol, elongation of the allotted alteplase window has the potential to significantly improve ischemic stroke outcomes.

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