Early Alteplase Benefits Stroke More Than Later
(HealthDay News) — Alteplase delivered within 4.5 hours of acute ischemic stroke onset is associated with increased odds of a good stroke outcome irrespective of age or stroke severity and despite an increased risk of fatal intracranial hemorrhage, with earlier treatment associated with bigger proportional benefits, according to a review published online August 6 in The Lancet.
Jonathan Emberson, PhD, from the University of Oxford in the United Kingdom, and colleagues conducted a prespecified meta-analysis of individual patient data from 6,756 patients with acute ischemic stroke. Data were collected from nine randomized phase 3 trials comparing alteplase with placebo or open control.
The researchers found that alteplase increased the odds of a good stroke outcome (no significant disability at 3–6 months), and earlier treatment correlated with a larger proportional benefit. Regardless of age or stroke severity, the proportional benefits were similar. Alteplase correlated with significantly increased odds of symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within seven days. Mortality at 90 days was not significantly different between the groups (17.9% in alteplase group vs. 16.5% in the control group; hazard ratio, 1.11; 95% confidence interval, 0.99–1.25; P=0.07).
"Irrespective of age or stroke severity, and despite an increased risk of fatal intracranial hemorrhage during the first few days after treatment, alteplase significantly improves the overall odds of a good stroke outcome when delivered within 4.5 hours of stroke onset, with earlier treatment associated with bigger proportional benefits," the authors write.
Several authors disclosed financial ties to the pharmaceutical and medical device industries.