Auburn University, Harrison School of Pharmacy, Auburn, AL, USA.
Ann Pharmacother. 2011 Mar;45(3):364-71. doi: 10.1345/aph.1P525. Epub 2011 Mar 8.
To evaluate the literature regarding the use of intravenous tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke, focusing on the appropriate usage criteria and administration time window.
A PubMed and MEDLINE search was performed (1990-November 2010) using the key words alteplase, tissue plasminogen activator, thrombolytic, ischemic stroke, and cerebrovascular accident.
Clinical trials published in English were evaluated and relevant primary literature evaluating the use of tPA in acute ischemic stroke was included.
The NINDS (National Institute of Neurological Disorders and Stroke) trial revealed clinical efficacy of tPA in the treatment of acute ischemic stroke when administered within 3 hours of stroke symptom onset and served as the foundation for the American Heart Association/American Stroke Association (AHA/ASA) acute ischemic stroke guideline recommendations. The ECASS (European Cooperative Acute Stroke Study) I, ECASS II, and ATLANTIS (Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke), part A and B, trials each assessed the efficacy of tPA when administered beyond 3 hours of ischemic stroke onset, but the results of each trial did not support its use beyond 3 hours. The ECASS III trial showed clinical efficacy of tPA when administered up to 4.5 hours. The SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) and SITS-ISTR (Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Register) registries evaluated the safety and efficacy of tPA at both 3 and 4.5 hours and showed promising results. In 2009, the AHA/ASA stroke guidelines were updated to support the use of tPA in select patients up to 4.5 hours after symptom onset.
tPA is effective when administered up to 4.5 hours after ischemic stroke symptom onset in select patients. However, timely administration remains paramount to achievement of optimal therapeutic outcomes.
评估静脉注射组织型纤溶酶原激活剂（tPA）治疗急性缺血性脑卒中的文献，重点关注适当的使用标准和给药时间窗。
使用关键词“alteplase、tissue plasminogen activator、thrombolytic、ischemic stroke、cerebrovascular accident”，对 PubMed 和 MEDLINE 进行了 1990 年至 2010 年 11 月的文献检索。
评估发表的临床试验，并纳入评估 tPA 在急性缺血性脑卒中应用的相关原始文献。
NINDS（美国国立神经病学与卒中研究院）试验显示，在卒中症状发作后 3 小时内给予 tPA 治疗具有临床疗效，这为美国心脏协会/美国卒中协会（AHA/ASA）急性缺血性脑卒中指南推荐提供了依据。ECASS（欧洲合作急性卒中研究）I、ECASS II 和 ATLANTIS（alteplase 溶栓治疗急性非介入性卒中）A 和 B 部分试验分别评估了在缺血性卒中发作后 3 小时以上给予 tPA 的疗效，但每项试验的结果均不支持在 3 小时后使用。ECASS III 试验显示，在卒中症状发作后 4.5 小时内给予 tPA 具有临床疗效。SITS-MOST（溶栓治疗监测研究）和 SITS-ISTR（国际卒中溶栓登记研究）注册研究评估了 3 小时和 4.5 小时时 tPA 的安全性和疗效，结果令人鼓舞。2009 年，AHA/ASA 卒中指南更新，支持在特定患者中，在症状发作后 4.5 小时内使用 tPA。
在特定患者中，在卒中症状发作后 4.5 小时内给予 tPA 是有效的。然而，及时给药仍然是获得最佳治疗效果的关键。
