Abstract
Background
Stroke treatment is a continuum that begins with the rapid identification of symptoms
and treatment with transition to successful rehabilitation. Therapies for acute ischemic
stroke (AIS) may vary based on anatomic location, interval from symptom onset, and
coexisting health conditions. Successful therapy requires a seamless systematic approach
with coordination from prehospital environment through acute management at medical
facilities to disposition and long-term care of the patient. The emergency physician
must balance the benefits and risks of alteplase recombinant tissue plasminogen activator
(rtPA) for AIS management.
Objective
We review the recent medical literature on the topic of AIS and assess intravenous
rtPA for the following questions: 1) is there any applicable, new, high-quality evidence
that the benefits of intravenous rtPA are justified in light of the harms associated
with it, and 2) if so, does the evidence clarify which patients, if any, are most
likely to benefit from the treatment.
Methods
A MEDLINE literature search from January 2010 to October 2016 and limited to human
studies written in English for articles with keywords of cerebrovascular accident
and (thromboly* OR alteplase). Guideline statements and nonsystematic reviews were
excluded. Studies targeting differences between specific populations (males vs. females)
were excluded. Studies identified then underwent a structured review from which results
could be evaluated.
Results
Three hundred twenty-two papers on thrombolytic use were screened and nine appropriate
articles were rigorously reviewed and recommendations given.
Conclusions
No new studies published between 2010 and 2016 meaningfully reduced uncertainty regarding
our understanding of the benefits and harms of intravenous rtPA for AIS. Discussions
regarding benefit and harm should occur for patients, and risk prediction scores may
facilitate the conversation.
Keywords
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Article info
Publication history
Published online: March 12, 2018
Footnotes
The views expressed in this manuscript do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.
Identification
Copyright
Published by Elsevier Inc.
