CardioExchange Archive

Time Window for TPA in Stroke Extended to 4.5 Hours: A new pooled analysis in the Lancet provides evidence that rt-PA may be beneficial when given up to 4.5 hours after stroke onset. Kennedy Lees and colleagues added data from 2 recent trials (ECASS III and EPITHET) to 6 earlier trials to re-examine the effect of time to treatment. As in previous analyses, earlier time to treatment was associated with better outcomes. No benefits were observed when rt-PA was given after 4.5 hours. In an accompanying comment, Jeffrey Saver and Steven Levine write that the findings “mandate a renewed commitment by clinicians and policy makers to foster very early intervention. We need to increase the proportion of patients arriving at hospital in the first, golden hour after ischaemia onset…. In thrombolytic stroke therapy, sooner is better than later, much better.”