TPA in CVA

Q: The benefit of alteplase in reperfusion therapy for acute ischemic stroke is similar regardless of patient age or stroke severity?

A) True

B) False

Answer: A

In contrast to conventional belief, the benefit of alteplase in reperfusion therapy for acute ischemic stroke is similar regardless of patient age or stroke severity. This came from a huge meta-analysis combining NINDS, ATLANTIS, ECASS, EPITHET, and IST-3 trials (6756 patients). Moreover, the risk of fatal intracranial hemorrhage stays similar regardless of age, stroke severity, or treatment delay. 

Although as expected the Odd Ratio (OD) of symptomatic intracranial hemorrhage stays high when compared to control, the number needed to harm (NNH) for one additional patient to have symptomatic intracranial hemorrhage is found to be 18. 

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References:

1. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384:1929.

2. Lees KR, Bluhmki E, von Kummer R, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375:1695.

3. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014; 384:1929.