What is Emergency Medicine -What proof is there that tissue plasminogen activator (tPA) reduces the risk of acute ischemic stroke?
The only thrombolytic that the US Food and Drug Administration (FDA) has currently approved for acute stroke is alteplase (commonly known as tPA). When administered within three hours of the onset of symptoms, tPA improved functional outcome (as measured by the modified Rankin scale) at three months, according to a 1995 National Institute of Neurological Disorders and Stroke (NINDS) experiment, with a number required to treat (NNT) of six. In 2008, ECASS III demonstrated a comparable improvement in functional result across a 3- to 4.5-hour period (NNT514). There has never been evidence in any stroke literature to far that systemic injection of tPA in individuals with suspected stroke reduces mortality. The PRISMS trial recently showed that there was no benefit of tPA versus aspirin alone for patients with an NIHSS of 5.
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