Alteplase for Stroke

Readers of this News Blog will probably have seen a post on thrombolysis with alteplase for acute ischaemic stroke. A meta-analysis of individual data from 6,756 patients and nine RCTs has now reported.[1] It concludes:

Irrespective of age or stroke severity, and despite an increased risk of fatal intracranial haemorrhage during the first few days after treatment, alteplase significantly improves the overall odds of a good stroke outcome when delivered within 4·5 h of stroke onset, with earlier treatment associated with bigger proportional benefits.”

— Richard Lilford, CLAHRC WM Director

Reference:

  1. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384(9958): 1929-35.
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2 thoughts on “Alteplase for Stroke”

  1. Dear Editor,
    one of your notes in this issue was closed: “Perhaps the more interesting findings will come from … Asia”. May I add that one should pay attention to the unusual wording in the review: “the overall odds of a good stroke outcome” is underscored. Attentive reader may find that authors honestly report that mortality is increased under A, but the increase is later faded away. Any way, the survival rate is NOT increased.
    So, what is visible from the East? UK scholars of the enigmas of Russian mortality explain the fast increase of the Russian longevity during a decade by implementation of the stroke care and the hypertension management. Because these interventions are heavily sold internationally, the explanation looks like reasonable.
    From the mentioned above study we learn that A therapy do not increase the survival. So, what about hypertension therapy?
    In RCTs the screening for and therapy of hypertension do reduce the stoke incidence. But the influence on the mortality is negligible (if exist at all).
    Of course this is not against the interventions mentioned, but about our explanations. They are important, because they determine the next studies. (Both W. James and I. Pavlov nicely laid it in elegant form, which I may not reproduce by heart.)

    1. I got it: “the whole meaning of a conception expresses itself in practical consequences, consequences either in the shape of conduct to be recommended, or in that of experiences to be expected, if the conception be true” WJ

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