Tissue Plasminogen Activator: A Literature Review

Context: The production of thrombolytic agents started in 1930s and thrombolytic therapy for stroke began in 1958, on a case by case basis, and, in 1963, a small trial performed.Evidence Acquisition: Intravenous tissue plasminogen activator (t-PA) was recognized and approved as the thrombolytic agent for acute ischemic stroke that can improve patients’ outcome and resolve their neurological deficits. The main reason for the difficulty of stroke treatment is the narrow time window, which leads to a small proportion of eligible patients to be treated with t-PA. The cost-effectiveness and feasibility of intravenous t-PA for treatment of acute stroke in 3 - 4.5 hour time window, after symptom onset, have been confirmed in previous studies. Data about thrombolytic therapy, at the national level, are scarce in Asia and developing countries, compared to developed world. Thrombolytic therapy using t-PA is used in few low-income countries, including Iran. According to estimations of Iranian stroke patients, eligible for thrombolysis therapy, only 30% of Iranian stroke patients received t-PA. The high cost of t-PA and lack of appropriate infrastructure are the main barriers for thrombolytic therapy, in developing countries like Iran. On the other hand, most stroke units and centers, which have the infrastructure to deliver thrombolysis, are predominantly available only in large urban areas.