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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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Commentary on: Emberson J, Lees KR, Lyden P, et al., Stroke Thrombolysis Trialists’ Collaborative Group. 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;384:1929–35.

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 just over 500 patients. It was clear from earlier …

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  • Competing interests None declared.