Preliminary research suggests that the blood clot-dissolving drug alteplase may improve stroke recovery chances by more than 50% when administered within 24 hours of ischemic stroke onset. The data was displayed during the American Stroke Association’s International Stroke Conference 2025. Professor Min Lou from Zhejiang University School of Medicine and the lead author of the study confirmed that this discovery assures stroke patients who cannot receive clot-dissolving treatment within current 4.5-hour regulations.
The drug alteplase is approved in the U.S. for stroke treatment when administered during the first three hours after symptom onset. Clinicians provide the treatment to select patients for a period extending beyond the 3-hour mark up to 4.5 hours.
New studies indicate that alteplase may benefit stroke patients treated between 4.5 and 9 hours after symptom onset. When delivered to ischemic stroke patients within 4.5 hours, IV alteplase is the recognized standard treatment in the U.S., as stated by the 2019 guidelines of the American Heart Association and American Stroke Association.
A study evaluating 372 patients who experienced a stroke between 4.5 and 24 hours served as the focus of evaluation. CT perfusion scanning revealed brain tissue preservation potentials for patients in the research. Scientists divided 372 stroke patients into two treatment groups. The first received alteplase clot-busting drugs, but the second group received the standard therapy of antiplatelet medication according to Chinese stroke treatment protocols. The examination of patients’ post-treatment recovery occurred at 90 days following intervention.
The research outcomes show that stroke patients can lead a good quality of life or near-complete recovery after treatment, which commences beyond previous time limits, according to Lou’s statement. CT perfusion imaging tools are expected to become standard practice. The apparatus allows doctors to monitor blood flow patterns in different brain areas affected by ischemic strokes, thus expanding treatment options for stroke patients across the world.
A study found that stroke patients who were treated with alteplase had much more recovery chances than those receiving the basic treatment. 40% of patients who received alteplase had minimal to no disability at 90 days compared with only 26% of the standard care group with the same recovery, which also provided alteplase patients with a 54% greater chance to regain function. The research involved 372 stroke patients in 26 Chinese hospitals. They had an average age of 72, and 43% were female.
Patients were randomized to either the conventional treatment group or the alteplase group. Finding out how many patients had little to no disability (a score of 0 or 1 on the modified Rankin scale) after 90 days was the primary objective of the research.
The risk of brain bleeding was slightly higher in the alteplase group (3.8%) compared to the standard care group (0.5%), but researchers believe this risk can be managed. Meanwhile, the death rate was the same for both groups at 10.8%. Additionally, less than 3% of patients in either group needed a mechanical clot removal procedure as extra treatment.
Researchers used widely available CT perfusion imaging to determine which patients still had brain tissue that could be saved, making the results more relevant to real-world treatment.
Lou emphasized the importance of determining the safety and effectiveness of other stroke-clot busters, including tenecteplase, especially when administered outside the standard time windows. He also stressed the need to determine whether these findings apply to other patient groups, particularly in regions where stroke risk and healthcare access vary.
Reference: Clot-busting meds may be effective up to 24 hours after initial stroke symptoms. Published February 07, 2025. Accessed February 19, 2025. Clot-busting meds may be effective up to 24 hours after initial stroke symptoms | American Heart Association
