Early experience with community implementation of thrombolysis three to 4.5 hours after acute ischemic stroke.

The therapeutic time window for IV thrombolytic treatment was recently extended at Hartford Hospital to 4.5-hours. We assessed the safety and efficacy of delayed thrombolysis.All patients given IV tPA for acute ischemic stroke (AIS) since 2006 were assessed. The risk of sICH in patients given tPA < or = three-hours vs > three-hours from onset of symptoms and acute change in NIH Stoke Scale (NIHSS) was evaluated.sICH rates were higher in patients who received IVtPA > three-hours (7.7%, n=39) compared to patients treated in the zero to three-hour window (4.0%, n=251; P = 0.30) but this was not statistically significant.Administration of tPA in the three to 4.5-hour window appears to be a safe alternative for patients presenting after three-hours. Caution is advised however, as sICH rates trended higher in patients in the three to 4.5-hour cohort.