Neurology  |  Stroke Pathway - Thrombolysis Therapy


Stroke Pathway - Thrombolysis Therapy

Alteplase (rt-PA) in Acute Ischemic Stroke

You (or your whanau-relative) are being considered for treatment with Alteplase, a recombinant tissue plasminogen activator (rt-PA). In order to decide whether you wish to receive therapy, you should understand enough about the possible risks and benefits to make an informed decision. You will have about 15 minutes to consider this. An interpreter will be provided if at all possible within the time constraints of treatment.


Most stokes are caused by loss of blood supply to a part of the brain. This is usually due to a clot in a blood vessel supplying the affected part of the brain. Dissolving the clot with Alteplase can restore the blood flow to the affected brain and may reduce the amount of permanent brain damage. Alteplase is only given after your consent and following discussion of the potential benefits and risks of treatment. Alteplase is given by injection into a vein over 1 hour.

What are the possible benefits of receiving Alteplase?

Alteplase has been shown to reduce the risk of disability in stroke patients treated up to 4.5 hours after the onset of stroke symptoms. The earlier Alteplase treatment can be given, the greater the chance of improved outcome. This is the reason for the short time in which to make a decision. This time-dependent effect of treatment can be demonstrated with the ‘number’s needed to treat’ to see significant benefit. One patient treated with Alteplase has a significantly improved outcome for every:

  • Three patients treated within 1.5 hours
  • Eight patients treated within 3 hours, 1 has a significantly improved outcome
  • Fourteen patients treated between 3-4.5 hours, 1 has a significantly improved outcome

These figures take into account the increased risk of bleeding with Alteplase.


What are the possible risks from receiving Alteplase?

Treatment with Alteplase significantly reduces the risk of death or disability following stroke. There is an increased risk of bleeding into the brain but this risk is outweighed by the benefits of treatment.

Alteplase is generally well tolerated but you (or your whanau-relative) may experience one or more of the following side effects.

  • Bleeding into the brain. This is the major risk of Alteplase treatment and may lead to permanent disability or death. Bleeding can occur into the stroke damaged brain as the clot is broken down but may also occur elsewhere in the brain. Bleeding into the brain with clinical deterioration occurs in less than 3% of patients treated with Alteplase. This risk of treatment has to be balanced against the potential for reducing the size of the stroke.
  • Bleeding from the gut or urinary tract. This bleeding may be difficult to control, and occasionally the loss of blood may require medical treatment including a blood transfusion.
  • Bruising or bleeding from the injection site, nose or gums. Generally, such bleeding is easily controlled.
  • An inflamed and painful injection site.
  • Other infrequent risks of Alteplase treatment include a transient rise in body temperature, lowering of blood pressure, nausea and vomiting, rash or breathing problems. Should any of these occur your doctor would be ready to treat with appropriate medication.
  • As with all new drugs, there may be other risks we do not know about.


You can ask for any information you want

The decision whether or not you wish to receive Alteplase is your choice. If you choose not to receive this treatment you do not have to give a reason and you will continue to receive all standard care for stroke patients. If you would like more information about Alteplase or if there is any matter about it that concerns you, either now or in the future, do not hesitate to ask one of the clinical team treating you.

Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016

Disclaimer: This site is intended to be flexible and frequently updated. While every effort has been made to ensure accuracy, all information should be verified.