Pharmacotherapy Updates of Recombinant Tissue Plasminogen Activator (r-TPA) in Acute Ischemic Stroke

Context: According to published articles, thrombosis is the main reason for death all over of the world. With stroke time missing is brain missing, therefore, the FDA-approved drug r-TPA, could be administered as initial IV bolus in less than 3 - 4.5 hours from onset of Acute Ischemic Stroke (AIS). The aim of this review was to provide updated pharmacotherapy related to r-TPA in AIS. Evidence Acquisition: Searches for associated published articles were conducted in major databases until September 2015. The main terms used in the search were a combination of words and phrases such as ischemic stroke and tissue plasminogen activator. Results: Age, time of onset, systolic blood pressure, diabetes, stroke severity, co-morbidities and premorbid medical situation, stroke scale according to national institute of health and outcomes related to CT (head, angiogram and perfusion) were considered when determining successful treatment by endovascular thrombectomy. According to the 2015 guidelines, strategies related to successful pharmacotherapy management should be based on class I evidence-care on a stroke unit, IV-r-TPA within 3 - 4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive cranioctomy for supratentorial malignant hemispheric cerebral infarction. Hemorrhagic stroke (intraparenchymal, subarachnoid, intraventricular, intracerebral such as orolingual angioedema), hematoma(epidural and subdural) and head trauma are the absolute contraindications related to r-TPA prescription. Conclusions: Due to considerable inter- and intra- heterogeneity among studies performed by other centers such as differences in study project, background, and population features, determining a pharmacotherapy model based on Safe Implementation of Treatments in stroke or SITS seem advantageous.