When should intravenous recombinant tPA be administered for the treatment of ischemic stroke?

Intravenous recombinant tissue plasminogen activator (tPA) is a thrombolytic agent used to treat ischemic stroke, and its administration is critical for improving patient outcomes. The recommended time frame for its use is within 3 to 4.5 hours from the onset of stroke symptoms. This time window is based on clinical studies that demonstrate a significant reduction in disability if tPA is given within this period.

Administering tPA during this window maximizes its effectiveness in dissolving the clot that is blocking blood flow to the brain, which can reduce the extent of brain damage and improve recovery chances. Treatment beyond this time frame has been associated with increased risks, including hemorrhagic transformation and potential worsening of the patient's condition. Therefore, timely intervention is key in managing ischemic stroke, and adhering to the 3 to 4.5 hours recommendation is essential for optimal patient care.

Earlier administration, such as within 1 hour, while beneficial, is not a standard guideline, as the critical evidence supports the 3 to 4.5-hour time frame. Waiting until 6 to 8 hours could pose significant risks and is also outside the evidence-based recommendations. Lastly, while prompt neurologic consultation is important,