Intravenous recombinant tissue plasminogen activator administered after 3 h following onset of ischaemic stroke: a metaanalysis*

ObjectiveTo assess the efficacy of intravenous recombinant tissue plasminogen activator administered after 3 h following onset of ischaemic stroke.BackgroundSome recent data indicate that treatment with intravenous recombinant tissue plasminogen activator may be beneficial even when administered to ischaemic stroke patients beyond 3 h from symptom onset.MethodsWe searched the medical literature using the MEDLINE, BIOSIS, and Cochrane databases for pertinent publications from 1966 to 2008 using the keywords ‘alteplase’, ‘tissue plasminogen activator’, and ‘stroke’. Among the retrieved publications, we selected randomised controlled trials that administered recombinant tissue plasminogen activator during 3–6 h after symptom onset in patients with acute ischaemic stroke. We evaluated the effect of intravenous recombinant tissue plasminogen activator (compared with placebo) on the rate of good functional outcome (determined by modified Rankin Scale of 0–1) and mortality at three-months. A subset analysis was ...