Key result
IV rt-PA within 3 hours of ischemic stroke prevents death or disability with NNT 8.
Why the study?
Intravenous thrombolysis with rtPA is approved for acute ischemic stroke within 3 hours, but its use is limited by a narrow time window, bleeding risk, and doubts about effectiveness.
Number Needed to Treat: 8
Number Needed to Treat: 8
Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) within 3 h of symptom onset is currently approved for treatment of acute ischemic stroke. Those who present within 3 h and have a vascular occlusion and a good CT scan are the ideal candidates for thrombolysis. Clinical trials and phase IV data has shed substantial light on the factors associated with more favorable outcomes with tPA. In the 3-6 h time window, cerebral perfusion information can be used for selection of patients for thrombolytic therapy. In many special circumstances, such as seizure at stroke onset, stroke on awakening, age more than 80 years, and patients with rapidly improving symptoms, the decision to treat depends on expert judgment. Due to the narrow time window, the fear of bleeding complications, and doubts regarding its effectiveness, tPA is still underused. Constant efforts are required to educate the public on the fact that stroke is a treatable emergency.
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Sylaja et al. (2008) conducted a review in Acute ischemic stroke. Intravenous recombinant tissue plasminogen activator (rtPA) vs. No thrombolytic therapy / Placebo was evaluated on Death or disability (NNT 8). Intravenous thrombolysis with recombinant tissue plasminogen activator administered within 3 hours of acute ischemic stroke onset improves favorable outcomes, with a number needed to treat of 8 to prevent one death or disability.
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