Tissue plasminogen activator for acute ischaemic stroke

Julia J Batmanian, Meeyin Lam, Caitlin Matthews, Andrew Finckh, Martin Duffy, Robert Wright, Bruce J Brew and Romesh Markus
Med J Aust 2008; 188 (8): . || doi: 10.5694/j.1326-5377.2008.tb01732.x
Published online: 21 April 2008

In reply: We welcome the opportunity to respond to issues raised by Hurley and Toncich. Australian, United States and European stroke guidelines based on level 1, grade A evidence recommend intravenous recombinant tissue plasminogen activator (IV-rtPA) for patients with acute ischaemic stroke (AIS) who meet specific inclusion criteria and present within 3 hours of AIS onset.1,2 Recombinant tPA is approved for this indication by the Therapeutic Goods Administration.

  • 1 St Vincent’s Hospital, Sydney, NSW.
  • 2 University of New South Wales, Sydney, NSW.


  • 1. Adams HP Jr, Del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke. Stroke 2007; 38: 1655-1711.
  • 2. National Stroke Foundation. Clinical guidelines for acute stroke management. Melbourne: NSF, 2007. (accessed Feb 2008).
  • 3. Wardlaw JM, del Zoppo G, Yamaguchi T, Berge E. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2003; (3): CD000213.
  • 4. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007; 369: 275-282.
  • 5. Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol 2004; 61: 346-350.
  • 6. Ingall TJ, O’Fallon WM, Asplund K, et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke 2004; 35: 2418-2424.
  • 7. Reed SD, Cramer SC, Blough DK, et al. Treatment with tissue plasminogen activator and inpatient mortality rates for patients with ischemic stroke treated in community hospitals. Stroke 2001; 32: 1832-1840.
  • 8. Hill MD, Buchan AM; Canadian Alteplase for Stroke Effectiveness Study (CASES) Investigators. Thrombolysis for acute ischemic stroke: results of the Canadian Alteplase for Stroke Effectiveness Study. CMAJ 2005; 172: 1307-1312.


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