Alteplase May Improve Outcomes When Given 4.5-24 Hours After Stroke in Select Patients: JAMA

Results showed that 40% of patients treated with alteplase achieved functional independence (modified Rankin Scale score of 0–1) at 90 days, compared to only 26% in the control group-a statistically significant benefit (adjusted risk ratio 1.52; P = .004). While the treatment group faced a higher rate of symptomatic intracranial hemorrhage (3.8% vs. 0.5%; adjusted risk ratio 7.34; P = .01), overall mortality at 90 days was equivalent between groups (11%).

These findings suggest that, in carefully selected patients identified via perfusion imaging, alteplase may extend its therapeutic benefit well beyond the traditional time window, offering functional gains even when endovascular options aren’t pursued. However, the elevated bleeding risk underscores the need for meticulous patient selection and monitoring. Still, this research could pave the way toward expanding thrombolytic therapy in resource-limited settings or for patients arriving late—so long as salvageable tissue is confirmed via imaging.