6 Intravenous Fibrinolysis for Acute Ischemic Stroke

Timothy J. Ingall

Abstract

With the discovery in the 1990s that intravenous fibrinolytic treatment with recombinant tissue plasminogen (tPA) is an effective treatment for acute ischemic stroke resulting in favorable outcomes, health care providers finally had a treatment they could offer to acute stroke patients arriving at hospitals within 3 hours of either symptom onset or when they were last known to be at their usual baseline. However, owing to safety concerns in the medical community, and a lack of organized stroke systems of care, the rate of the utilization of tPA for the treatment of acute ischemic stroke from 1996 through 2005 was low. Clinical studies documenting that it was safe to extend the time window for treatment out to 4.5 hours, along with continued revision of national stroke organization guidelines emphasizing the efficacy and relative safety of tPA utilization for acute ischemic stroke, encouraged stroke care providers to consider tPA treatment for acute ischemic stroke in a broader range of clinical scenarios. More importantly, the development of stroke telemedicine programs, and the implementation of multiple stroke systems of care in different communities have significantly increased the rate of tPA utilization for the treatment of acute ischemic stroke over the last 15 years. Intravenous fibrinolysis with tPA remains a cornerstone of acute stroke treatment to improve clinical outcomes. It is used as either stand-alone treatment or, in carefully selected patients, in conjunction with endovascular mechanical clot retrieval.

Schlüsselwörter

fibrinolysis - recombinant tissue plasminogen activator - tenecteplase - stroke systems of care - stroke telemedicine - stroke quality measures

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