Benefits of tPA Treatment After Stroke Vary with Time

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A new study, presented at the 9th World Stroke Congress last month, showed that treatment with intravenous recombinant tissue plasminogen activator (tPA) within 4.5 hours of acute ischemic stroke can increase the risk of early death but also improves the odds for survival without significant disability.

The meta-analysis, which was conducted by Peter Sandercock, MD of the University of Edinburgh in the United Kingdom, and colleagues revealed that early treatment with tPA increases the risk of death from intracerebral hemorrhage, but has little to no effect on other causes of early death.

The study involved 6,756 patients from nine trials, with a primary efficacy endpoint of a modified Rankin Scale (mRS) score of zero or one at three to six months post-stroke.

Treatment with tPA at one hour post-stroke had an odds ratio of about 1.85. That decreased to about 1.2 at five hours post-stroke. Treatment with tPA up to three hours post-stroke showed a benefit on mRS scores at the three to six-month mark compared to control patients. The researchers noted that the benefit of the tPA diminished the later it was administered.

Although patients treated with tPA had an increased risk of intracerebral hemorrhage or death within seven days, by three months, the researchers concluded that the earlier risk of death associated with early treatment was offset by the improved survival benefits. 

IV drip
Benefits of tPA Treatment After Stroke Vary with Time

Intravenous recombinant tissue plasminogen activator (tPA) within 4.5 hours of the onset of acute ischemic stroke increases the early risk for death but gives better odds of surviving without significant disability and possibly yields later mortality benefits, a recent meta-analysis shows.

"Earlier treatment results in bigger proportional benefits, and tPA, although it does increase the early risk of death from intracerebral hemorrhage, has no significant effect on other causes of early death," Peter Sandercock, MD, professor of medical neurology at the University of Edinburgh, United Kingdom, reported.

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