In a significant move for stroke treatment, researchers at the University of Cincinnati have found that a commonly used clot-busting drug, alteplase, could be effective even when administered up to 24 hours after the onset of acute ischemic stroke symptoms. The traditional window has been much narrower—just a few hours. The study, published in JAMA, demonstrated a notable increase in the rate of functional independence among patients treated with the drug.
According to the University of Cincinnati's news release, the HOPE trial showed that 40.3% of the patients who received alteplase achieved functional independence after 90 days, compared to only 26.3% of those who got standard care. There was a concern of a higher initial rate of symptomatic intracranial hemorrhage in the alteplase group, but no significant increase in mortality after 90 days.
"These findings support extending the therapeutic window for IV thrombolysis in appropriately selected patients when endovascular thrombectomy is not initially planned or indicated," the researchers asserted, as per UC News. This breakthrough could potentially revolutionize treatment protocols and improve outcomes for stroke patients worldwide.
Not all regions have access to the potentially more effective stroke treatment known as thrombectomy—a procedure to mechanically remove a blood clot. Eva Mistry, MBBS, an associate professor from the UC College of Medicine and a physician at the UC Gardner Neuroscience Institute, emphasized the practical applications of this study, "That still concerns me in terms of generalizability of the results outside of resource-poor settings where thrombectomy isn’t available," she told TCT MD through UC News. In places without such facilities, Mistry notes the encouraging aspect of the trial, saying, "that now, patients may be considered for a reperfusion therapy based on advanced imaging selection in the extended time window."
The HOPE trial results could effectively extend the help for stroke patients beyond urban centers and into areas where rapid treatment options are limited, especially in low-to middle-income countries struggling with inadequate medical resources and longer transfer times. The conversation has now shifted towards ensuring advanced imaging techniques are available to identify those who could benefit from this extended-window treatment approach.
