WAKE-UP
MRI-Guided Thrombolysis for Stroke with Unknown Time of Onset
Patient / Population Intervention / Exposure Comparison Outcome
In 503 patients with ischaemic stroke of unknown onset and DWI–FLAIR mismatch, alteplase improved mRS 0–1 at 90 days versus placebo.
N
503
Design
Double-blind RCT; stopped early due to funding
Endpoint
mRS 0–1 at 90 days
Relevance
2
Result53.3% vs 41.8% (adj. OR 1.61; 95% CI 1.09–2.36; p=0.02). Numerically higher mortality with alteplase.
Thomalla G, et al. N Engl J Med. 2018;379(7):611-622. 10.1056/NEJMoa1804355
Discussion & critique
Enables MRI-selected thrombolysis in wake-up stroke.