Safety and efficacy of alteplase in the treatment of acute ischemic stroke

Figures & data

Table 1 Results of major trials on use of endovenous rt-PA. Report of the 90-day outcome for patients treated with alteplase

Name of study	Treatment window	sICH	Mortality at three months	Independence at three months
NINDS	3 hours	10.9%	17%	47.2%
SITS-MOST	3 hours	7.3%	11.3%	54.8%
ECASS I	6 hours	24.9%	22.3%	41.6%
ECASS II	6 hours	8.5%	10%	40.3%
ATLANTIS	3–5 hours	6.9%	17.3%	34%
ECASS III	3–4.5 hours	2.4%	7.7%	52.4%

Abbreviations: ATLANTIS, Alteplase Thrombolysis for Acute Non-interventional Therapy in Ischemic Stroke; ECASS, European Cooperative Acute Stroke Study; NINDS, National Institute of Neurological Disorders and Stroke; rt-PA, tissue plasminogen activator; sICH, symptomatic intracerebral hemorrhage; SITS-MOST, Safe Implementation of Thrombolysis in Stroke-Monitoring Study.

Table 2 Risk factors for hemorrhagic transformation in acute ischemic stroke following thrombolysis

Clinical factors	Biochemical markers	Radiologic factors
Thrombolytic agent (dose, route of administration, time of onset to thrombolysis, type of agent)	Elevated blood glucose	Early ischemic change on CT
Stroke severity	Elevated red cell count	Large volume infarct, edema, or mass effect on the baseline CT
Advancing age	Elevated matrix metalloproteinase	Presence of lacune
History of diabetes	Elevated calcium-binding proteins	Reduced blood volume on PWI
Elevated blood pressure	Early fibrinogen degradation coagulopathy	Breakdown of blood–brain barrier
History of cardiac failure		Presence of microbleeds on MRI Leukoariosis on MRI

Abbreviations: CT, computed tomography; MRI, magnetic resonance imaging; PWI, perfusion-weighted image.