Systemic Thrombolysis by Alteplase for Acute Ischemic Stroke

Key Messages

• Evidence was summarized to determine the effect of alteplase in adult stroke patients.
• There is substantial uncertainty concerning the evidence due to the risk of bias in the available studies and imprecision in how the magnitude of the treatment effects were estimated.
• The identified research suggests that alteplase administered within 3 hours of a stroke might result in:
  • fewer deaths after 18 months and little-to-no difference in death after 7 days, 3 months, 6 months, or 3 years
  • increased brain bleeds after 7 days but no difference after 36 hours or after 3 months
  • improvements in functioning and independence after 7 days and after 6 months; at 3 months, some studies showed no difference in independence and another study showed higher functioning.
• The identified research suggests that alteplase administered between 3 hours and 4.5 hours after a stroke might result in:
  • little-to-no difference in deaths after 3 months; at 7 days, some evidence showed little-to-no difference in death while other evidence suggested more deaths
  • little-to-no differences in brain bleeds after 36 hours; at 7 days, some evidence showed no effect on brain bleeds, while other evidence showed more brain bleeds
  • no differences in functioning and independence after 6 months; at 3 months, some evidence showed no effect on functioning, while other evidence reported improved functioning.