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Thrombolysis for ischaemic stroke: impact of the extension of the time-window in daily practice
  1. Marie Mihout1,
  2. Charlotte Cordonnier2,3,4,
  3. Isabelle Girard-Buttaz1,
  4. Didier Leys2,3,4
  1. 1Department of Neurology, Hospital of Valenciennes, France
  2. 2Univ Lille Nord de France, Lille, France
  3. 3UDSL, Lille, France
  4. 4CHU Lille, EA 1046, Lille, France
  1. Correspondence to Didier Leys, Department of Neurology, Stroke Unit, Roger Salengro Hospital, Rue Emile Laine, F-59037 Lille, France; dider.leys{at}chru-lille.fr

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Intravenous recombinant tissue plasminogen activator (rt-PA) administered within 3 h after onset in patients with acute ischaemia in the territory of the middle cerebral artery increases the proportion of patients who are left without handicap after 3 months.1 The ECASS-3 trial showed that there is also a benefit in patients treated between 3 and 4.5 h.2 Although the current labelling is still restricted to the 3-h time-window in the European Union, the European Stroke Organisation has already recommended extending it to 4.5 h (http://www.esostroke.org/pdf/ESO%20Guidelines_update_Jan_2009.pdf). In a large survey that included 11 262 acute stroke patients admitted in 60 hospitals from England, Wales and Northern England, only 14% met criteria for thrombolysis based on a 3-h time-window.3 If the time-window was extended to 4.5 h, only another 2% would have become eligible,3 suggesting that it would have a marginal effect on …

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