What are the benefits of thrombolytic therapy following a stroke?

Updated: Jan 24, 2018
  • Author: Jeffrey L Saver, MD, FAHA, FAAN; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Answer

Thrombolytics restore cerebral blood flow in some patients with acute ischemic stroke and may lead to improvement or resolution of neurologic deficits.

Thrombolytic therapy is of proven and substantial benefit for select patients with acute cerebral ischemia. The evidence base for thrombolysis in stroke includes 21 completed randomized controlled clinical trials enrolling 7152 patients, using various agents, doses, time windows, and intravenous or intra-arterial modes of administration . [1, 2] Data from these trials are congruent in supporting the following conclusions:

  • Intravenous fibrinolytic therapy at the cerebral circulation dose within the first 3 hours of ischemic stroke onset offers substantial net benefits for virtually all patients with potentially disabling deficits.

  • Intravenous fibrinolytic therapy at the cerebral circulation dose within 3-4.5 hours offers moderate net benefits when applied to all patients with potentially disabling deficits.

  • MRI of the extent of the infarct core (already irreversibly injured tissue) and the penumbra (tissue at risk but still salvageable) can likely increase the therapeutic yield of lytic therapy, especially in the 3- to 9-hour window.

  • Intra-arterial fibrinolytic therapy in the 3- to 6-hour window offers moderate net benefits when applied to all patients with potentially disabling deficits and large artery cerebral thrombotic occlusions.


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