The future of stroke thrombolysis

Studies with tissue plasminogen activator (t‐PA) published in 1995 showed significant improvement in stroke outcome if the drug was administered within 3 hours from stroke onset. Several recent reports, however, show that less than 5% of stroke patients may be receiving t‐PA in many parts of North America. This paper explores how this may be improved by examining some of the steps taken in Canada, where a recent audit showed that 8.2% of ischemic stroke patients received t‐PA, and in those arriving within 2.5 hours to regional stroke centers in Ontario, 42.2% received t‐PA. The paper also reviews the potential for t‐PA to be given by more physicians, in remote regions using Telestroke, the possibility for using imaging characteristics rather than the onset of stroke as a determinant of eligibility for t‐PA, the status of contraindications for thrombolysis, and the possibility of combining t‐PA with immune modulation for improved stroke outcomes.