Breakthrough Discovery: Alteplase Effective Up to 24 Hours Post-Stroke Onset
In a significant breakthrough for stroke treatment, preliminary research presented at the American Stroke Association’s International Stroke Conference 2025 in Los Angeles has shown that alteplase, a clot-dissolving medication, can enhance stroke patients’ recovery by more than 50% when given up to 24 hours after the onset of ischemic stroke.
This development provides hope to stroke patients worldwide who currently face limited access to time-sensitive clot-dissolving treatments. In China, where the study took place, alteplase is approved for administration within 4.5 hours of stroke symptoms. In the U.S., it is approved for use within three hours, with extended use up to 4.5 hours for certain patients.
Study Details and Results
Professor Min Lou, M.D., Ph.D., from the Second Affiliated Hospital of Zhejiang University’s School of Medicine in China, led the study. Researchers enrolled 372 patients whose symptoms began 4.5 to 24 hours earlier. They used CT perfusion imaging, a form of advanced brain scanning, to identify patients with salvageable brain tissue.
Participants were randomly divided into two groups: one received alteplase, while the other received standard stroke care, including antiplatelet therapy as directed by the Chinese Guidelines for Diagnosis and Treatment of Acute Ischemic Stroke 2018.
We believe these findings mean more people may return to normal or near-normal lives after a stroke, even if they receive treatment later than originally thought beneficial. This method of treatment could become the new standard, especially in hospitals that use CT perfusion imaging. This technology helps health care professionals see how blood flows in different parts of the brain after an ischemic stroke. This could extend treatment eligibility to millions more patients across the globe.
Min Lou, M.D., Ph.D., Professor at the Second Affiliated Hospital of Zhejiang University’s School of Medicine, China
The study found a 54% higher chance of functional recovery among participants treated with alteplase compared to those receiving standard care. At the 90-day mark, 40% of patients in the alteplase group had minimal or no disability, versus 26% in the control group.
Risk Factors and Further Research
Researchers observed higher rates of brain bleeding (3.8%) among alteplase recipients compared to those who did not receive the medication (0.5%). However, they believe this risk is manageable.
Professor Lou highlighted the need for further investigation into the safety and efficacy of other clot-dissolving medications, such as tenecteplase, for extended treatment windows. It is also essential to explore whether these findings apply to diverse populations and healthcare settings.
Study Limitations
Several limitations should be considered. The study was conducted in a multicenter, prospective, randomized trial involving 26 stroke centers in China. Both participants and researchers were aware of the assigned treatment, which could introduce bias.
Further studies are required to determine if these results generalize to patients in other regions with varying stroke risks and healthcare resources.
Conclusion
This groundbreaking research challenges current frameworks for stroke treatment and offers new hope for millions of stroke patients globally. If validated, the use of alteplase up to 24 hours after stroke onset could extend the window of treatment for many patients, significantly improving stroke recovery rates.
As a community, we must continue to invest in research to expand access to effective treatments and improve patient outcomes. Stay tuned for further developments in this exciting field.
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