[Alteplase treatment for acute stroke 2007: an effective therapeutic option at our disposal].

INTRODUCTION

The greatest progress has been made in the research field based on the early arterial recanalization strategy in cerebral ischemia.

AIM

To carry out a revision of stroke treatment with intravenous thrombolysis during the therapeutic window period covering the first three hours of evolution. The revision focuses on information provided by clinical trials, meta-analysis and open-label reports studies.

DEVELOPMENT

Clinical trials that study the use of alteplase in the acute stroke treatment, especially the two phase III clinical trials carried out by the National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group, are described. A great deal of useful information has been provided through systematic revisions that analyze data on these treatment clinical trials jointly. Meta-analysis studies are described: the Pooled Analysis of ATLANTIS, ECASS and NINDS t-PA Stroke Trials, Cochrane Meta-analysis: Thrombolysis for Acute Ischemic Stroke. Community based studies, especially the SITS-MOST study, were revised, and their findings were compared with other open-label t-PA studies.

CONCLUSIONS

t-PA is effective when administered in the first three hours of evolution of stroke in selected patients and under ideal conditions, and it may be beneficial, using the same selection criteria, in a therapeutic window of four and a half hours. The treatment is effective when applied as part of the daily clinical practice in our environment. This effectiveness does not disappear when extending its use to a large number of qualified hospitals.