Why the Window for tPA Got Wider - ECASS III

On the Shoulders of Giants

I still want to believe...
ECASS III was a large RCT of patients with acute ischemic stroke presenting 3-4.5 hours from the time of onset.  Similar to NINDS, more had a favorable outcome with alteplase than placebo, NNT = 14.  But more also had symptomatic intracranial hemorrhage, NNH = 45 (NNH = 23 by the NINDS definition).

Spoon Feed
The window for tPA got wider with this study; ECASS III expanded the time of administration to 4.5 hours.  But earlier is still better when it comes to stroke treatment.

Here are some great FOAMed resources on tPA in stroke.

Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke.
N Engl J Med. 2008 Sep 25;359(13):1317-29. doi:10.1056/NEJMoa0804656.