Extended-Window Thrombolysis Improves Functional Outcomes After Acute Ischemic Stroke

A systematic review and meta-analysis found that intravenous thrombolysis (IVT) given 4.5 hours or more after acute ischemic stroke onset was associated with better functional outcomes, although it increased the risk of symptomatic intracerebral hemorrhage (ICH). The analysis included 14 randomized clinical trials involving 4,174 patients comparing IVT with placebo or standard medical care through March 3, 2026. At 90 days, IVT increased the likelihood of an excellent functional outcome (modified Rankin Scale [mRS] score 0–1; RR, 1.22) and a good functional outcome (mRS score 0–2; RR, 1.12). Mortality did not differ significantly between groups (RR, 1.13), but symptomatic ICH was more frequent with thrombolysis (RR, 2.44). In absolute terms, approximately 12–16 patients would need to be treated to achieve one additional favorable functional outcome, while 62 patients would need to be treated for one additional symptomatic ICH. The findings support extending IVT beyond the conventional 4.5-hour window in appropriately imaging-selected patients with acute ischemic stroke. Source: https://jamanetwork.com/