Thrombolytic Therapy for Acute Ischemic Stroke Management

Thrombolytic therapy for acute ischaemic stroke employs intravenous administration of fibrinolytic agents to dissolve occlusive thrombi in cerebral arteries, restoring blood flow and limiting neuronal injury. The standard agent, alteplase, is most effective when delivered within 4.5 hours of symptom onset, with benefit diminishing as onset‐to‐treatment time increases. Early intervention reduces disability, though it carries a small risk of symptomatic intracranial haemorrhage. Refinements in treatment protocols include extension of the time window in select patients using advanced imaging, development of tenecteplase as a single‐bolus alternative, and integration with endovascular thrombectomy for large‐vessel occlusions. Organised stroke pathways, mobile stroke units and computerised decision aids have improved timely delivery of treatment and personalised risk–benefit communication. Ongoing research focuses on optimising patient selection, novel thrombolytic agents with greater fibrin specificity and combining pharmacological and mechanical approaches. Globally, expansion of infrastructure, training and cost considerations drive equitable access, while long‐term data support sustained functional benefit beyond three months and improved survival in treated cohorts.

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Thrombolytic Therapy for Acute Ischemic Stroke Management publication trend

The graph below shows the total number of articles in thrombolytic therapy for acute ischemic stroke management across all publications each year (not limited to Nature Index journals).

Technical terms

Thrombolytic agent: Drug that promotes clot breakdown by converting plasminogen to plasmin.

Alteplase: Recombinant tissue plasminogen activator used intravenously to lyse cerebral thrombi.

Tenecteplase: Genetically modified plasminogen activator with longer half-life and single-bolus administration.

Reperfusion: Restoration of blood flow to ischaemic brain tissue.

Modified Rankin Scale: Six-point scale measuring functional disability after stroke (0 = no symptoms to 5 = severe disability).

Symptomatic intracranial haemorrhage: Clinically significant brain bleeding accompanied by neurological deterioration.

References

1. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. The Lancet (2014).
2. Acute ischaemic stroke: recent advances in reperfusion treatment. European Heart Journal (2022).
3. Tenecteplase vs. alteplase for acute ischemic stroke: a systematic review. International Journal of Emergency Medicine (2022).
4. Efficacy and safety of thrombolysis for acute ischemic stroke with atrial fibrillation: a meta-analysis. BMC Neurology (2021).
5. Development of a computerised decision aid for thrombolysis in acute stroke care. BMC Medical Informatics and Decision Making (2015).
6. Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke. Stroke (2018).