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CMAJ • August 7, 2001; 165 (3)
© 2001 Canadian Medical Association or its licensors

Review
Synthèse

Update on intravenous tissue plasminogen activator for acute stroke: from clinical trials to clinical practice

David J. Gladstone and Sandra E. Black

Dr. Gladstone is a Stroke Fellow in the Division of Neurology, Department of Medicine, Sunnybrook and Women's College Health Sciences Centre, and is a trainee in the Royal College of Physicians and Surgeons of Canada's Clinician Investigator Program at the University of Toronto, Toronto, Ont. Dr. Black is Head, Division of Neurology, and Codirector, Stroke Research Unit, Sunnybrook and Women's College Health Sciences Centre, and is Professor of Medicine (Neurology), University of Toronto, Toronto, Ont.

Correspondence to: Dr. Sandra Black, Cognitive Neurology, Unit A421, Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave., Toronto ON M4P 3M5; fax 416 480-4552

Abstract

TISSUE PLASMINOGEN ACTIVATOR (TPA) INJECTED INTRAVENOUSLY within 3 hours of symptom onset has emerged as a treatment option for acute ischemic stroke. Although controversial and not universally accepted, its use in carefully selected patients is supported by evidence from randomized controlled trials and by mounting community experience. In this paper we review the literature published in the past 5 years regarding the safety, clinical trial efficacy and real-world effectiveness of intravenous tPA for stroke. First we review data from the phase III clinical trials on which approval for tPA is based. Then we summarize a growing literature of postmarketing phase IV studies and discuss the limitations and challenges that lie ahead. Our aim is to provide clinicians with an overview of this evolving therapy.




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