Title：tPA use in 4.5-6 hours of CVA
题目：组织纤维蛋白溶酶原激活剂（tPA）在脑梗死后4.5-6小时内的应用
Author 作者: Michael Abraham, Bryan Hayes, and Sarah Dubbs

1. Background (背景资料)
Standard of care is to give tPA within 3 hours of symptom onset
脑梗死3小时内使用tPA是标准的治疗措施
There is good data that suggests good outcomes in those even within 3 – 4.5 hour window
有数据支持在3－4。5小时内使用也可改善预后
These two articles look into if the window can be extended further to 6 hours
最近有两个文章报告了是否可以将时间延长到6个小时

2. Lancet article 1 柳叶刀文章一
Randomized control trial looking at around 3000 patients who had ischemic strokes within the 4.5 – 6 hour window since symptom onset
随机对照试验，包括3000个在发病后4。5－6小时内就诊的缺血性脑梗死的病人
~1500 patients received tPA and ~1500 received a saline control
大约1500人接受了tPA，另外1500人得到了生理盐水作为对照
c. Results found that tPA patients who survived 7 days up to 6 months had a
comparable morbidity and mortality to those patients who did not receive tPA
结果显示接受tPA的活到7天到6个月病人的合并症和死亡率与没有接受tPA的 病人相式
245 died who received tPA vs. 300 died who did not receive tPA
tPA组有245人死亡，对照组有300人死亡
Before 7 days, 11% died who received tPA vs. 7% died who did not receive tPA
7天内的死亡率在tPA组为11％，对照组为7％

3. Lancet article 2 柳叶刀文章二
Wardlaw et al took 12 articles of patients who were given tPA within 6 hours, pooled their data, and looked at their outcomes through data analysis
Wardlaw等人对12篇6小时内使用tPA的文章进行了总结，对他们的预后结果 进行了分析
7012 patients total 一共有7012个病人
Results showed chances of death increased within 7 days in the patients who got tPA (9% in those who received tPA vs. 6% in those who did not) and chance of symptomatic intracranial hemorrhage increased within 7 days (7.7% in those who received tPA vs. 1.8% in those who did not)
结果显示tPA增加了病人7天的死亡率（9％在tPA组，6％在对照组）和有症状 颅内出血发生频率（7.7％在tPA组，1.8％在对照组）
After 7 days, patients who received tPA were found to have higher benefit from a functional standpoint
7天以后，得到tPA的病人在功能恢复方面要好于对着组
the number of deaths were similar between the two groups at 6 month follow up and the number with independent function was higher in patients who received tPA
在6个月随访时，两组病人的死亡率相式，但独立功能恢复的人数在tPA 组要高

Bottom line （要点）
No convincing evidence to suggest it is safe to give tPA for the 4.5 – 6 hour window
没有有力证据支持tPA在发病后4.5-6小时内的安全使用

References 参考文献:

1. IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. The Lancet. 2012; 379 (9834): 2352 - 63, 23.
2. Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. The Lancet. 2012; 379 (9834): 2364-2372.