Past, present and future of alteplase for acute ischemic stroke

Abstract

Thrombolysis for acute ischemic stroke has revolutionized stroke medicine. The only agent licensed for clinical use is the tissue plasminogen activator alteplase. A considerable evidence base confirms clinical and economic efficacy of alteplase use in selected patients. Meta-analyses suggest that for every 100 patients treated within 3 h, 32 will achieve a better outcome, while only three will suffer an important bleeding complication. These good-quality trial data are complemented by over a decade’s worth of clinical experience that confirms the efficacy and safety of alteplase. Studies designed to enhance efficacy are ongoing. Unfortunately, current rates of thrombolysis remain disappointingly low. Thus, while novel approaches to lysis administration are welcome, strategies to improve lay-public and medical awareness of acute stroke and potential treatments are also required.

Keywords::

• alteplase
• cerebrovascular accident
• clinical trial
• drug approval
• tissue plasminogen activator
• thrombolytic therapy

Conflict of interest

Kennedy R Lees has been principal investigator for several acute stroke trials including trials of neuroprotectant (GAIN, SAINT, SAINT II) and novel lytic strategies (DIAS).

Financial & competing interests disclosure

Kennedy R Lees has received fees, expenses and institutional grants relating to these and other trials from GlaxoSmithKline, AstraZeneca and several other pharmaceutical companies that have been or are developing treatments for stroke. Terence J Quinn, Jesse Dawson, Kennedy R Lees have applied for academic grant support to continue work on developing stroke outcome assessments for use in acute stroke trials. This work was funded departmentally.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Notes

Data extracted from European Cooperative Acute Stroke Study trial.