Medications to break the clot can be effective up to 24 hours after the initial symptoms of stroke

These results give hope to patients in the world around the world that may not be able to access medicines to dissolve the clot within the approved time window, which in China is within 4.5 hours, said the main investigator of the trial , Min Lou, MD, Ph.D., a professor in the second affiliate hospital at the Faculty of Medicine of the University of Zhejiang in China.

In the US, the alteplass is approved to treat stroke within three hours after the start of the symptoms and is recommended for use up to 4.5 hours for selected patients. Another investigation has indicated that it can also work well in some patients from 4.5 to 9 hours after the start of stroke.

The American Heart Association/American Stroke Association 2019 The guidelines for early management of patients with acute ischemic stroke keep in mind that alteplase IV within 4.5 hours after the start of the stroke of stroke is the standard of care for most of the majority of the Patients with ischemic stroke in the United States.

The researchers registered 372 patients with stroke whose symptoms began 4.5 hours 24 hours before. They used widely available CT perfusion images (advanced brain scan) to confirm that these patients still had brain tissue that could recover with treatment. The participants were randomly divided into two groups: a group received the alteplase of medicines that destroy the clot, while the other received the care of standard stroke of the antiplatelet therapy at the discretion of the researcher, depending on the Chinese guidelines for the diagnosis and the treatment of acute ischemic stroke 2018 stroke. The functional recovery was evaluated at 90 days.

“We believe that these findings mean that more people can return to normal or almost normal lives after a stroke, even if they receive treatment later than it originally thought beneficial,” Lou said. “This method of treatment could become the new standard, especially in hospitals that use CT perfusion images. This technology helps health professionals to see how blood flows in different parts of the brain after an ischemic stroke .

The study found:

• 40% of the participants treated with Alteplase had little or no disability after 90 days, compared to 26% of those who received standard attention, 54% higher of probability of functional recovery.
• Less than 3% of the participants in any of the groups received the elimination of mechanical rescue clots as an additional treatment.
• The death rates were the same (10.8%) for both groups.
• The risk of brain bleeding was greater among those who received alteplass than among the participants than (3.8% compared to 0.5%), but researchers believe that this is a manageable risk.

“We must also analyze more closely how safe and effective other medications to dissolve the clot, such as the tectaplase, when they are administered after a stroke, especially beyond the usual deadlines. It is also important to learn if our findings apply to others Groups of people.

The limitations of the study include that both the participants and the researcher knew what treatment was being given, which could have introduced the bias, and the results may not be generalizable for patients outside China.

Study design, background and details:

• The study registered 372 patients with stroke in a multicenter, prospective and random trial in 26 stroke centers in China.
• The patient’s average age was 72 years old, and 43% were women.
• The trial used CT perfusion image software widely available to measure recoverable brain tissue, which makes the findings more applicable to real world clinical environments.
• The registered patients were assigned to the Altepase Group or a standard medical treatment group.
• The primary result was a score of 0 or 1 on the modified Rankin scale, which obtains a disability of 0 (without symptoms) to 6 (death) at 90 days.