incomplete Journal Club Article
IST-3 collaborative group. "The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial.". Lancet. 2012. 379(9834):2352 - 2363.
PubMed Full text

Clinical Question

Can use of fibrinolytics for acute ischemic stroke be extended to a wider range of patients up to 6 hours?


Thrombolysis within 6 hours improved functional outcome even though there were early hazards. This applies to the population of patients recruited for IST-3, benefits appear to be seen in the elderly as well.

Major Points

Study Design

  • International, randomized controlled trial
  • open treatment

Inclusion Criteria

  • Signs and symptoms of acute stroke
  • Known time of stroke onset
  • Treatment could be started within 6 hours of onset
  • CT or MRI excluded ICH and brain lesion
  • Patient and clinician felt the treatment was "promising but unproven"
  • If patient had indication for IV thrombolysis- treated with local guidelines

Exclusion Criteria



Primary Outcomes

Secondary Outcomes

Subgroup analysis



UK Medical Research Council, Health Foundation UK, Stroke Association UK, Research Council of Norway, Arbetsmarknadens Partners Forsakringsbolag (AFA) Insurances Sweden, Swedish Heart Lung Fund, The Foundation of Marianne and Marcus Wallenberg, Polish Ministry of Science and Education, the Australian Heart Foundation, Australian National Health and Medical Research Council (NHMRC), Swiss National Research Foundation, Swiss Heart Foundation, Assessorato alla Sanita, Regione dell'Umbria, Italy, and Danube University.