In reply: Stroke experts around the world consider that the evidence for thrombolysis with tissue plasminogen activator (tPA) within 3 hours is overwhelming. Licensing authorities such as the Therapeutic Goods Administration in Australia and the Food and Drug Administration in the United States have approved use of tPA after rigorous, independent analysis of all the available data. However, it seems that a minority of sceptical emergency physicians remains, who will probably never be convinced. Further trials in the sub-3-hour time window are unlikely to receive ethical approval. The focus of stroke research has now moved on. Current targets include expansion of the time window and alternative approaches to recanalisation such as intra-arterial thrombolysis and clot retrieval.
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