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Stroke patients benefit from dissolving a blood clot in the brain up to 4.5 hours after a stroke

Patients can still benefit up to 4.5 hours after a stroke if a drug that dis-solves blood clots in the brain is administered. Thus far, three hours had been considered the useful limit for administering thrombolytic drugs. The results of the “European Cooperative Acute Stroke Study 3” (ECASS 3) have now been published in the “New England Journal of Medicine”.


“These new insights will benefit tens of thousands of patients whose cerebral circulation could be restored“, said the study director, Professor Dr. Werner Hacke, Medical Director of the Neurology Clinic at Heidelberg University Hospital, who presented the study at the World Stroke Congress in Vienna.


A total of 826 patients in 130 European stroke centers who were treated in the clinic between 3 and 4.5 hours after a stroke were injected with either the thrombolytic drug alteplase or a placebo. Cerebral hemorrhage as a cause of the stroke was first ruled out by CT scan.


The earlier the treatment, the better the result 

Around 52 percent of the patients treated with alteplase responded well to treatment and suffered no or only slight impairment, while in the placebo group, there were only 45 percent responders. The mortality rate was very low and identical in both groups (8 percent). 


Based on these results, the researchers suggest treating stroke patients with thrombolytic drugs even after three hours. “But having more time does not mean that we can take more time”, warned Professor Hacke. Pa-tients with signs of a stroke should still be brought to the hospital and treated as soon as possible. Previous analyses clearly showed that pa-tients respond best the earlier they received treatment.


But in addition to this, the study will set an important course – there had been no positive study on acute stroke therapy for more than 12 years, and ECASS 3 is just the second acute study ever to have a positive result for strokes. “This study will have an impact on the entire field of stroke treat-ment. It has finally been demonstrated again that stroke can be treated and this will encourage many researchers and companies to continue to work in this field”, according to Professor Hacke.


About stroke: Every year, more than 250,000 people in Germany suffer a stroke and more than 10 million patients die annually from strokes all around the world, making it the second most frequent cause of death in the world, now ahead of cancer. As life expectancy increases, a dramatic increase in the incidence of strokes is expected in Germany, but even more so in developing countries. Stroke is not fate, it can be prevented and treated!


Professor Dr. Werner Hacke
Medical Director of the Neurology Clinic at Heidelberg University Hospital
Tel.: 06221 / 56 8211 (office)
E-mail: Neurologie@med.uni-heidelberg.de


Hacke W et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. 2008. New England Journal of Medicine, Sept. 25, Vol. 359, p. 1317-1329.

(The original article can be requested at the press office of Heidelberg Uni-versity Hospital at contact@med.uni-heidelberg.de .)


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Professor Dr. Werner Hacke, Medical Director of the Neurology Clinic at Heidelberg University Hospital.

Photo: Heidelberg University Hospital


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