Systemic Thrombolysis by Alteplase for Acute Ischemic Stroke

Key Message

Evidence was summarized to determine the effect of alteplase in adult stroke patients. There is substantial uncertainty concerning the evidence due to the risk of bias in the available studies and imprecision in how the magnitude of the treatment effects were estimated.

The identified research suggests that alteplase administered within 3 hours of a stroke might result in:

• fewer deaths after 18 months and little-to-no difference in death after 7 days, 3 months, 6 months, or 3 years
• increased brain bleeds after 7 days but no difference after 36 hours or after 3 months
• improvements in functioning and independence after 7 days and after 6 months; at 3 months, some studies showed no difference in independence and another study showed higher functioning.

The identified research suggests that alteplase administered between 3 hours and 4.5 hours after a stroke might result in:

• little-to-no difference in deaths after 3 months; at 7 days, some evidence showed little-to-no difference in death while other evidence suggested more deaths
• little-to-no differences in brain bleeds after 36 hours; at 7 days, some evidence showed no effect on brain bleeds, while other evidence showed more brain bleeds
• no differences in functioning and independence after 6 months; at 3 months, some evidence showed no effect on functioning, while other evidence reported improved functioning.