Alteplase May Improve Stroke Recovery Up to 24 Hours After Symptoms

Recent study presented at the American Stroke Association's International Stroke Conference 2025 suggests that the clot-dissolving medication alteplase could significantly improve recovery outcomes for stroke patients, even when administered up to 24 hours after the onset of symptoms(1^✔ ✔Trusted Source
Clot-busting meds may be effective up to 24 hours after initial stroke symptoms

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Extended Treatment Window Offers New Hope

In a randomized clinical trial conducted in China, researchers found that administering alteplase up to 24 hours after the initial signs of an ischemic stroke increased the odds of better recovery by over 50% compared to standard antiplatelet treatments. This marks a substantial extension from the current treatment guidelines, which recommend alteplase within 3 to 4.5 hours of symptom onset in the U.S.

Key Findings of the Study

The trial involved 372 stroke patients aged around 72, with 43% being women. Researchers used CT perfusion imaging to identify patients with brain tissue still salvageable despite the delayed treatment. Participants were split into two groups: one receiving alteplase and the other standard antiplatelet therapy.

• Improved Recovery: 40% of patients treated with alteplase had little to no disability after 90 days, compared to 26% in the standard care group.
• Manageable Risks: The risk of brain bleeding was slightly higher in the alteplase group (3.8% vs. 0.5%), but researchers deemed this risk manageable.
• Mortality Rates: Both groups had identical death rates of 10.8%.

Implications for Global Stroke Care

Dr. Min Lou, the principal investigator from Zhejiang University’s School of Medicine, emphasized the potential global impact of these findings. "More people may return to normal or near-normal lives after a stroke, even if treated later than previously thought beneficial," Lou stated.

The results are particularly promising for regions with limited access to advanced medical procedures, as the use of CT perfusion imaging is increasingly available worldwide.

Researchers call for further studies to evaluate the safety and efficacy of other clot-dissolving medications like tenecteplase beyond traditional time frames. They also stress the need to confirm whether these findings apply to diverse populations with varying stroke risks and healthcare infrastructures.

While the findings are preliminary and await peer-reviewed publication, they represent a significant advancement in stroke treatment. If validated, this could lead to updated global guidelines, potentially saving lives and improving the quality of life for millions of stroke survivors worldwide.

Reference:

1. Clot-busting meds may be effective up to 24 hours after initial stroke symptoms - (https://newsroom.heart.org/news/clot-busting-meds-may-be-effective-up-to-24-hours-after-initial-stroke-symptoms-american-stroke-association-international-stroke-conference-late-breaking-science-presentation-lb-41)

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Source-Medindia