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NICE changes guidance on stroke drug alteplase

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More stroke victims could now be given alteplase on the NHS if treatment can be started within a few hours of them developing symptoms.

UK drugs watchdog NICE issued final guidance for the drug, which helps break down clots, to be used to treat acute ischaemic stroke. Alteplase (Actilyse, Boehringer Ingelheim) is now recommended for use by the NHS if it can be given to the patient up to four and a half hours after they first start displaying symptoms and if tests show they have not had an intracranial haemorrhage.

This comes after the licence for alteplase was altered giving a longer window of time when the tissue plasminogen activator can be used. In the past, it had to be administered within three hours of the first stroke symptom whereas now the licence covers treatment for an extra 90 minutes.

Alteplase works by stimulating the body so it creates the enzyme plasmin, which breaks down fibrin clots making it easier for blood to pass through a blocked artery.

It is administered during the acute phase of the stroke and activates the production of plasmin, an enzyme that degrades fibrin clots thereby helping to restore blood flow through the blocked artery.

Professor Carole Longson, NICE health technology evaluation centre director, said: “We know that stroke is one of the biggest killers and causes of disability, therefore it is important that patients receive treatments that can help to reduce the effects of a stroke as quickly as possible. The benefits of alteplase in reducing long term disability caused by stroke are well recognised.

“However, because alteplase needs to be given within 4.5 hours of the onset of symptoms, these benefits can only be realised if brain imaging to confirm a diagnosis of acute ischaemic stroke is received as soon as possible, and certainly within one hour of arrival at the hospital, as per the NICE Quality Standard for Stroke.

“To that end the independent Appraisal Committee heard from clinical specialists that Accident and Emergency departments of all acute care hospitals in England and Wales must have access to 24-hour, 7-day a week brain imaging facilities.

“Today’s guidance recommending the use of alteplase within the extended time frame for which it is now licensed has the potential to have a significant impact on the treatment of thousands of patients.”

 

 

 

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Readers' comments (1)

  • As a Paramedic, it will be interesting to see if the NHS adopt this amended position and consider providing this drug on its Ambulance fleet.

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