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Systematic review and meta-analysis
Ateplase for ischaemic stroke: increased risk of intracranial haemorrhage is balanced by improved stroke outcomes, particularly if treated within 3–4.5 h of onset
  1. Anthony Rudd
  1. Division Health and Social Care, Kings College London, London, UK
  1. Correspondence to : Professor Anthony Rudd, Division Health and Social Care, Kings College London, London se17eh, UK; anthony.rudd{at}

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Implications for practice and research

  • Thrombolysis given to appropriate patients within 4.5 h of the onset of stroke symptoms increases the chance of a good outcome. The earlier it is given, the more likely it is to be effective.

  • Thrombolysis increases the risk of early death, but by 3–6 months mortality is equivalent in treated and untreated patients.


The first major trial showing the benefit of alteplase for acute ischaemic stroke was published 20 years ago and involved …

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