Predicted impact of intravenous thrombolysis on prognosis of general population of stroke patients: simulation model

Alteplase (recombinant tissue plasminogen activator) can be used to dissolve blood clots and achieve reperfusion in some stroke patients. Three randomised controlled trials have studied its clinical effect.1–3 A US trial studied patients who were treated within three hours of onset of stroke and reported a 32% (95% confidence interval 1% to 70%) relative increase in the proportion of patients with full recovery but no effect on overall mortality.1 This led to approval of alteplase for stroke patients in the United States. A European trial of patients treated within six hours of stroke onset was negative,2 and a second trial, published recently, reported no significant positive effect.3 An application for European approval of alteplase treatment within three hours of stroke onset is being considered. Alteplase often leads to bleeding and should be given only by …