Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke

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The second attempt to extend the time window of rtPA administration was the Alteplase Throm-bolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study (45 ). Like ECASS II, ATLANTIS was originally designed to show if the benefits of systemic thrombolysis could extend up to 6 hr. After the publication of the NINDS study in 1995, the time window for enrollment was changed to encompass 3 to 5 hr. The primary endpoint for the modified study was good outcome, defined as an NIHSS score of 0 or 1 at 90 days. After 761 patients had been enrolled in ATLANTIS, the trial was terminated prematurely because of projected lack of benefit with active treatment. Again, no difference in mortality was observed between the 2 treatment groups, suggesting that "delayed" administration of rtPA was safe. The ATLANTIS investigators followed the precedent observed in ECASS II by concluding that the use of rtPA for acute ischemic stroke should not be undertaken after 3 hr.

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