Tissue plasminogen activator for acute ischaemic stroke

Batmanian, Julia J; Lam, Meeyin; Matthews, Caitlin; Finckh, Andrew; Duffy, Martin; Wright, Robert; Brew, Bruce J; Markus, Romesh

doi:10.5694/j.1326-5377.2008.tb01732.x

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In reply: We welcome the opportunity to respond to issues raised by Hurley and Toncich. Australian, United States and European stroke guidelines based on level 1, grade A evidence recommend intravenous recombinant tissue plasminogen activator (IV-rtPA) for patients with acute ischaemic stroke (AIS) who meet specific inclusion criteria and present within 3 hours of AIS onset.1,2 Recombinant tPA is approved for this indication by the Therapeutic Goods Administration.

1 St Vincent’s Hospital, Sydney, NSW.
2 University of New South Wales, Sydney, NSW.

Correspondence: rmarkus@stvincents.com.au

1. Adams HP Jr, Del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke 2007; 38: 1655-1711.
2. National Stroke Foundation. Clinical guidelines for acute stroke management. Melbourne: NSF, 2007. http://www.strokefoundation.com.au/news/welcome/clinical-guidelines-for-acute-stroke-management (accessed Feb 2008).
3. Wardlaw JM, del Zoppo G, Yamaguchi T, Berge E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2003; (3): CD000213.
4. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369: 275-282.
5. Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 2004; 61: 346-350.
6. Ingall TJ, O’Fallon WM, Asplund K, et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke 2004; 35: 2418-2424.
7. Reed SD, Cramer SC, Blough DK, et al. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke 2001; 32: 1832-1840.
8. Hill MD, Buchan AM; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005; 172: 1307-1312.

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