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Stroke

Expanded indications for stroke thrombolysis—what next?

Restrictions to thrombolytic therapy for stroke—recommended only up to 4.5 h after onset and in those under 80 years of age—limit its use. Results from a recent trial support expansion of both the inclusion criteria and the time window for thrombolytic therapy, but further research is needed.

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References

  1. Donnan, G. A., Fisher, M., Macleod, M. & Davis, S. M. Stroke. Lancet 371, 1612–1623 (2008).

    CAS  Google Scholar 

  2. Davis, S. M. & Donnan, G. A. Clinical practice. Secondary prevention after ischemic stroke or transient ischemic attack. N. Engl. J. Med. 366, 1914–1922 (2012).

    Article  CAS  Google Scholar 

  3. Whiteley, W., Lindley, R., Wardlaw, J. & Sandercock, P. Third international stroke trial. Int. J. Stroke 1, 172–176 (2006).

    Article  PubMed Central  Google Scholar 

  4. IST-3 collaborative group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 379, 2352–2363 (2012).

  5. Sandercock, P., Lindley, R., Wardlaw, J., Whiteley, W. & Murray, G. Statistical analysis plan for the third international stroke trial (IST-3); part of a 'thread' of reports of the trial. Int. J. Stroke 7, 186–187 (2012).

    Article  Google Scholar 

  6. Wardlaw, J. M. et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 379, 2364–2372 (2012).

    Article  CAS  PubMed Central  Google Scholar 

  7. Medcalf, R. L. & Davis, S. M. Plasminogen activation and thrombolysis for ischemic stroke. Int. J. Stroke 7, 419–425 (2012).

    Article  Google Scholar 

  8. Ma, H. et al. A multicentre, randomized, double-blinded, placebo-controlled Phase III study to investigate EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND). Int. J. Stroke 7, 74–80 (2012).

    Article  Google Scholar 

  9. Parsons, M. et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N. Engl. J. Med. 366, 1099–1107 (2012).

    Article  CAS  Google Scholar 

  10. Fiebach, J. B. et al. Vascular occlusion enables selecting acute ischemic stroke patients for treatment with desmoteplase. Stroke 43, 1561–1566 (2012).

    Article  Google Scholar 

Download references

Acknowledgements

Our research in this area is supported by a programme grant from the Australian National Medical Research Council and the Commonwealth Scientific and Industrial Research Organization. Support is also received from the Victorian Government Operational Infrastructure Scheme.

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Correspondence to Geoffrey A. Donnan.

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G. A. Donnan and S. M. Davis are co-Principle Investigators of the EXTEND trial for which Boehringer Ingelheim provide the drug and placebo, but no financial support.

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Donnan, G., Davis, S. Expanded indications for stroke thrombolysis—what next?. Nat Rev Neurol 8, 482–483 (2012). https://doi.org/10.1038/nrneurol.2012.151

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