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(Stroke. 2005;36:200.)
© 2005 American Heart Association, Inc.

Advances in Stroke 2004

Thrombolysis

What More Does It Take?

From the Department of Neurology, Helsinki University Central Hospital, University of Helsinki, Finland.

Correspondence to Prof Markku Kaste, Department of Neurology, Helsinki University Central Hospital, University of Helsinki, FI-00029 HUS Helsinki, Finland. E-mail markku.kaste@hus.fi

Key Words: Advances in Stroke • emergency medical services • stroke, acute • stroke, ischemic • stroke outcome • thrombolysis • thrombolytic therapy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Eight years have passed since the US Food and Drug Administration approved recombinant tissue plasminogen activator (rtPA) for stroke thrombolysis. The regulatory authorities of Canada approved it in 1999 and those of Germany in 2000. The European Agency for the Evaluation of Medicinal Products (EMEA) approved it for all member states in 2002, although only conditionally. One condition was that all treated patients must be included in a register, the Safe Implementation of Thrombolysis in Stroke: a Multinational, Multicenter Monitoring Study of Safety and Efficacy of Thrombolysis in Stroke (SITS-MOST). The conditional approval of EMEA made stroke thrombolysis available for many more Europeans. Finally, we had a drug that had been shown effective in acute ischemic stroke and was approved in most developed countries. However, has it changed the way acute ischemic strokes are treated? The answer is no, or, to be exact, not on as wide a scale as it could have. Doctors and medical centers have been slow in changing their practices. Of ischemic stroke patients treated in community hospitals, only 1.6% to 2.7% receive thrombolysis, and of those treated in academic hospitals or specialized stroke centers, only 4.1% to 6.3% receive thrombolysis.¹ There are many practical reasons for it.² Unfounded allegations have tried to deny the results of the pivotal National Institute of Neurological Disorders and Stroke (NINDS) rtPA trial,³ but the results from reanalysis of the NINDS trial verified the original observations.⁴ Although there is a need for more information about many still open questions related . . . [Full Text of this Article]

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