Intravenous Thrombolysis, Time Window, Dosage, and Off-Label

Abstract

Despite the development of Intravenous thrombolysis with tissue Plasminogen Activator (IVtPA) guidelines in each affiliated stroke center, protocol violations may be observed in each hospital with IVtPA facilities. An extensive search of scientific electronic databases including PubMed, OVID, Index Medicus, Index Copernicus, Google, ISI, and Scopus was performed with keywords of Thrombolysis, Off-label, Out of Protocol, Violation, Time Window, Dose, tPA, and Stroke terminated on 01 May 2018. Safety and functional outcomes are less favorable beyond three hours; however, the wider time window until 4.5 hours is recommended. Lower dose of alteplase (0.6 mg/kg) is approved in Japan. The proposed dose of tPA in Iranian population is similar to that of the Japanese. Overall, the outcomes in patients treated with off-label IVtPA or protocol violation were better than those of the controls based on registry data. There is little disagreement about time window of IVtPA. The dose of 0.6 mg/kg is used in some Asian countries with similar therapeutic results.

Keywords

• Stroke
• Tissue Plasminogen Activator