Doubts, fears and misconceptions. What is the future of thrombolysis in acute stroke?

Alteplase for acute ischemic stroke may be the first stroke intervention to have a significant public health impact. In February 1999, this therapy wa s conditionally licensed in Canada for acute ischemic stroke within three h ours of symptom onset. However, considerable controversy exists regarding i ts safety, its wider applicability outside clinical trials, and its ultimat e availability. In this article we review the thrombolytic literature, atte mpt to answer many of the concerns, provide new guidelines for its use, and cite the need for more information about whom we should and should not be treating with this therapy.