Recombinant Tissue Plasminogen Activator for the Treatment of Acute Ischemic Stroke (Pharmacology Notes‪)‬

Clinical practice guidelines published by both the American Heart Association and American Stroke Association (AHA/ASA) in 2007, and the American College of Chest Physicians in 2008, recommend the use of the thrombolytic agent recombinant tissue plasminogen activator (rtPA) for the treatment of acute ischemic stroke (AIS) in eligible patients (1, 2). Approved by the US Food and Drug Administration (FDA) in 1996 for treatment of AIS, intravenous rtPA (or alteplase) is the only thrombolytic agent approved for this indication to date (3). Due to the extremely small timeframe in which a patient is eligible to receive rtPA, it is estimated that only 3% to 5% of stroke sufferers reach a hospital in time to be considered for this treatment (4). This small number is discouraging because "the ultimate goal of early reperfusion therapy is to reduce or prevent brain infarction and thereby minimize the long term disability, neurologic impairment, and stroke-related mortality" (2). As stroke is the third most frequent cause of death in the USA, killing 137,000 people each year, mortality reduction could potentially spare the lives of a large number of patients (5). This article briefly reviews the evidence supporting the use of rtPA for AIS and focuses on important new literature that has impacted practice since the publication of the current AIS guidelines. BACKGROUND