SGEM#524: High, High HOPE for Recovery – Alteplase between 4.5 and 24 hours

Studien extrahiert aus dem Podcast von Dr. Ken Milne

• 2025HOPEEmergency & ResuscitationIn 372 patients with ischaemic stroke 4.5–24 hours after onset and salvageable tissue on perfusion imaging, alteplase improved excellent 90-day functional outcome compared with standard medical care.
• 2008ECASS IIIEmergency & ResuscitationIn 821 patients with acute ischaemic stroke treated 3 to 4.5 hours after onset, alteplase improved 90-day functional outcome but increased symptomatic haemorrhage compared with placebo.
• 2018WAKE-UPEmergency & ResuscitationIn 503 patients with stroke of unknown onset and MRI DWI-FLAIR mismatch, alteplase improved 90-day functional outcome (mRS 0–1) compared with placebo.
• 2019EXTENDEmergency & ResuscitationIn 225 patients with ischemic stroke 4.5–9 h after onset or on waking, with salvageable tissue on perfusion imaging, alteplase increased 90-day excellent functional outcome compared with placebo.
• 2024TIMELESSEmergency & ResuscitationIn 458 patients with large-vessel ischaemic stroke and salvageable tissue on perfusion imaging 4.5–24 h after onset, tenecteplase did not improve 90-day functional outcome compared with placebo.
• 2018PRISMSEmergency & ResuscitationIn 313 patients with minor nondisabling acute ischemic stroke, alteplase did not improve 90-day excellent functional outcome compared with aspirin.
• 2026Extended thrombolysis in acute ischemic stroke: A Bayesian meta-analysis and umbrella reviewEmergency & ResuscitationIn 6 RCTs of acute ischemic stroke beyond 4.5 h or of unknown onset, imaging-selected thrombolysis gave little utility-weighted mRS benefit and a likely mortality rise versus standard care.