Title of article :
Intravenous Thrombolysis, Time Window, Dosage, and Off-Label
Author/Authors :
Ghandehari, Kavian Department of Neurology - School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran , Hatamian, Hamidreza Department of Neurology - Poursina Hospital - Guilan University of Medical Sciences, Rasht, Iran , Shahedi, Sharife School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran , Valipour, Zahra School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran , Sobhani, Mohammad Reza Department of Neurology - School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran , Salehian, Hojat Department of Neurology - School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran , Nazemian, Shokat Department of Neurology - School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran , Rezae, Masumeh Department of Neurology - School of Medicine - Mashhad University of Medical Sciences, Mashhad, Iran
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 offlabel
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.
