SynthesisThe Journal of emergency medicine2011
Thrombolytic therapy for acute ischemic stroke beyond three hours.
Synthesis in The Journal of emergency medicine, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed.
- Noninvasive or minimally invasive neuromodulation in animal models of acute ischemic stroke: A systematic review and meta-analysis.Neuroprotection (Chichester, England) · 2026Article
- The Association between Serum Anion Gap and All-Cause Mortality in Cerebral Infarction Patients after Treatment with rtPA: A Retrospective Analysis.Disease markers · 2022Article
- Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals.International journal of health geographics · 2020Article
- Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction.The Journal of international medical research · 2020Article
- Potential Medications or Compounds Acting on Toll-like Receptors in Cerebral Ischemia.Current neuropharmacology · 2018Review
- Blood Occludin Level as a Potential Biomarker for Early Blood Brain Barrier Damage Following Ischemic Stroke.Scientific reports · 2017Article
- Predictors of in-hospital death and symptomatic intracranial hemorrhage in patients with acute ischemic stroke treated with thrombolytic therapy: Paul Coverdell Acute Stroke Registry 2008-2012.International journal of stroke : official journal of the International Stroke Society · 2014Article
- Toll-like receptors and ischemic brain injury.Journal of neuropathology and experimental neurology · 2014Review
- Neurorestorative therapy for stroke.Frontiers in human neuroscience · 2014Review
- Article
- Mechanically assisted intra-arterial thrombolysis in acute cerebral infarction.Experimental and therapeutic medicine · 2013Article
- Sex, stroke, and inflammation: the potential for estrogen-mediated immunoprotection in stroke.Hormones and behavior · 2013Review
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- Article
- Menstrual blood transplantation for ischemic stroke: Therapeutic mechanisms and practical issues.Interventional medicine & applied science · 2012Article
- Cytoprotective protein C pathways and implications for stroke and neurological disorders.Trends in neurosciences · 2011Review
- Protein S blocks the extrinsic apoptotic cascade in tissue plasminogen activator/N-methyl D-aspartate-treated neurons via Tyro3-Akt-FKHRL1 signaling pathway.Molecular neurodegeneration · 2011Article
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundIschemic cerebrovascular accidents remain a leading cause of morbidity and mortality. Thrombolytic therapy for acute ischemic stroke within 3h of symptom onset of highly select patients has been advocated by some groups since 1995, but trials have yielded inconsistent outcomes. One recent trial demonstrated significant improvement when the therapeutic window was extended to 4.5h. CLINICAL QUESTION: Does the intravenous systemic administration of tPA within 4.5h to select patients with acute ischemic stroke improve functional outcomes? EVIDENCE REVIEW: All randomized controlled trials enrolling patients within 4.5h were identified, in addition to a meta-analysis of these trial data.
resultsThe National Institute of Neurological Disorders and Stroke (NINDS) and European Cooperative Acute Stroke Study III (ECASS III) clinical trials demonstrated significantly improved outcomes at 3 months, with increased rates of intracranial hemorrhage, whereas ECASS II and the Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study showed increased hemorrhagic complications without improving outcomes. Meta-analysis of trial data from all ECASS trials, NINDS, and ATLANTIS suggest that thrombolysis within 4.5h improves functional outcomes.
conclusionIschemic stroke tPA treatment within 4.5h seems to improve functional outcomes and increases symptomatic intracranial hemorrhage rates without significantly increasing mortality.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.