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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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