Current management of acute ischemic stroke. Part 1: Thrombolytics and the 3-hour window.

OBJECTIVE To help family physicians who care for patients with acute stroke or who are involved in planning service delivery or resource allocation to understand recent developments in acute stroke care. QUALITY OF EVIDENCE A MEDLINE search indicated that most data were derived from well designed, randomized, double-blind, placebo-controlled trials, including all the largest international studies and large systematic reviews. MAIN MESSAGE Treatment of acute stroke with tissue plasminogen activator seems beneficial for certain patients with certain kinds of stroke. Because thrombolytic therapy is not without risk and requires substantial resources, it should be administered only by physicians trained in its use and in centres with the necessary experience and resources. Because time is important, an organized and efficient system of stroke care with collaboration between hospital and prehospital care providers and help from ordinary citizens is essential. CONCLUSION Management of acute stroke is an emerging discipline; many potential therapies are still experimental.