Early experience with community implementation of thrombolysis three to 4.5 hours after acute ischemic stroke.

Background: The therapeutic time window for IV thrombolytic treatment was recently extended at Hartford Hospital to 4.5-hours. We assessed the safety and efficacy of delayed thrombolysis.

Methods: All patients given IV tPA for acute ischemic stroke (AIS) since 2006 were assessed. The risk of sICH in patients given tPA < or = three-hours vs > three-hours from onset of symptoms and acute change in NIH Stoke Scale (NIHSS) was evaluated.

Results: sICH rates were higher in patients who received IVtPA > three-hours (7.7%, n=39) compared to patients treated in the zero to three-hour window (4.0%, n=251; P = 0.30) but this was not statistically significant.

Conclusions: Administration of tPA in the three to 4.5-hour window appears to be a safe alternative for patients presenting after three-hours. Caution is advised however, as sICH rates trended higher in patients in the three to 4.5-hour cohort.