Update on intravenous tissue plasminogen activator for acute stroke: from clinical trials to clinical practice

TISSUE PLASMINOGEN ACTIVATOR (TPA) INJECTED INTRAVENOUSLY within 3 hours of symptom onset has emerged as a treatment option for acute ischemic stroke. Although controversial and not universally accepted, its use in carefully selected patients is supported by evidence from randomized controlled trial s and by mounting community experience. In this paper we review the literat ure published in the past 5 years regarding the safety, clinical trial effi cacy and real-world effectiveness of intravenous tPA for stroke. First we r eview data from the phase III clinical trials on which approval for tPA is based. Then we summarize a growing literature of postmarketing phase IV stu dies and discuss the limitations and challenges that lie ahead. Our aim is to provide clinicians with an overview of this evolving therapy.