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Eur Neurol. 2011;65(3):170-4. doi: 10.1159/000324291. Epub 2011 Mar 3.

Thrombolysis with alteplase 4.5-6 hours after acute ischemic stroke.

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Department of Neurology, The Sixth People's Hospital/Shanghai Jiaotong University, Shanghai, China.



The safety of intravenous (IV) thrombolysis when administered between 4.5 and 6 h after acute ischemic stroke with alteplase has not been established.


The objective of this study was to investigate the safety of IV alteplase thrombolysis within a 6-hour time frame following ischemic stroke.


Eligible patients were categorized as having treatment within 4.5 h or from 4.5 to 6 h and were evaluated for the following end points: disability at 90 days as measured by the modified Rankin Scale, incidence of mortality, and type 2 parenchymal hemorrhages.


100 patients were enrolled in our study (58 within 4.5 h after stroke and 42 between 4.5 and 6 h). After 90 days, 47.6% of the patients in the 4.5-6 h group reached independence in comparison to 44.8% patients in the 4.5 h group (p = 0.840). The incidence of type 2 parenchymal hemorrhage in the patients treated between 4.5-6 h and those treated within 4.5 h were 7.1 and 8.6%, respectively (p = 1.00). The incidence of mortality was 7.1 and 17.2% for the 4.5-6 and 4.5 h groups, respectively (p = 0.228).


IV thrombolysis in patients who fulfill the NINDS study criteria may still be considered up to 6 h after ischemic stroke.

[Indexed for MEDLINE]

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