Systematic ReviewResearchMedication Safety

Late-window thrombolysis improved 90-day function in selected stroke patients but increased symptomatic bleeding

Neurology (PubMed)Jul 20, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A meta-analysis of 18 randomized trials involving 5,168 patients found that intravenous thrombolysis 4.5 to 24 hours after acute ischemic stroke improved 90-day functional outcomes in selected patients, while symptomatic intracranial hemorrhage increased and mortality did not.

What NurseJet pulled from the source

Fifteen studies representing 18 randomized trials compared intravenous thrombolysis with control beyond 4.5 hours from last known well. Most trials used advanced imaging to identify salvageable tissue. Excellent functional recovery at 90 days occurred in 40.3% with thrombolysis and 33.2% with control, while functional independence occurred in 54.5% and 50.1%, respectively. Symptomatic intracranial hemorrhage occurred in 3.2% versus 1.4%, and 90-day mortality did not differ significantly. Thrombectomy context explained much of the between-trial variation, so these findings apply to protocol-selected patients rather than everyone arriving late.

Why this matters for nurses

Stroke and emergency nurses help establish last-known-well time, activate pathways, obtain rapid imaging, and monitor after reperfusion treatment. The review reinforces that a late presentation may still warrant urgent stroke evaluation while highlighting the bleeding surveillance required after thrombolysis.

Bedside takeaway

Selected late-window stroke patients benefited from thrombolysis, but the higher bleeding risk keeps rapid evaluation and post-treatment surveillance essential.

How This Applies in Practice

Use this when: A patient with suspected acute ischemic stroke presents more than 4.5 hours after last known well or with an uncertain onset time.

On your shift

Activate the stroke pathway, establish last known well and relevant medication history, and prepare the patient for protocol-directed imaging without delay.
Communicate changes in neurologic findings, blood pressure, bleeding risk, and potential thrombectomy eligibility to the stroke team.
After thrombolysis, perform the ordered neurologic and bleeding surveillance and escalate headache, vomiting, acute hypertension, or neurologic decline immediately.

Keep in mind: Do not infer eligibility from time alone or select a thrombolytic regimen from this review. Follow the stroke protocol, facility policy, and patient-specific provider orders.

Explain this for my unit

Key takeaways

The analysis included 5,168 patients across 18 randomized trials of thrombolysis given 4.5 to 24 hours after acute ischemic stroke.
Excellent 90-day recovery increased from 33.2% with control to 40.3% with thrombolysis in the pooled analysis.
Symptomatic intracranial hemorrhage increased from 1.4% to 3.2%, while 90-day mortality was not significantly different.
Eleven trials required advanced imaging selection, and thrombectomy availability contributed substantially to heterogeneity.

Practice implications

Activate the stroke pathway promptly even when onset is beyond 4.5 hours, document last known well and eligibility information accurately, and expedite protocol-directed imaging and specialist review. After treatment, follow the ordered neurologic, blood-pressure, access-site, and bleeding monitoring schedule and escalate any deterioration immediately.

Limitations & cautions

Trials differed in thrombolytic agents, imaging selection, stroke territory, severity, and access to thrombectomy. Most participants were selected for favorable imaging rather than treated solely by clock time, and trial-level meta-regression cannot remove all confounding. The findings should not be generalized to unselected patients or used to choose reperfusion therapy without a stroke specialist and local protocol.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

Open source

Public citations are filtered to exact credible source pages. Homepage-only or invalid links stay in admin review and are not shown here.

Neurology (PubMed)

Neurology (PubMed). Exploring Between-Study Heterogeneity in Extended-Window IV Thrombolysis for Acute Ischemic Stroke: A Meta-Analysis of 18 Randomized Controlled Trials.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42475651/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

Related briefs

More updates for this clinical area

Back to Discover

Neurology (PubMed)Jul 23, 2026Systematic ReviewPractice applicable

An updated meta-analysis of 13 randomized studies and individual-patient-data meta-analyses found that IV thrombolysis beyond 4.5 hours improved 90-day functional outcomes in selected acute ischemic stroke patients while increasing symptomatic intracranial hemorrhage.

EmergencyAI summaryReview source

Systematic ReviewResearchWorkflowMedication SafetyPractice applicableAI summary · original source linked below

The pooled evidence included 2,456 patients receiving thrombolysis plus best medical therapy and 2,411 controls. Excellent functional outcome was more likely with thrombolysis, with a reported number needed to treat of 13, while symptomatic intracranial hemorrhage was also more frequent, with a reported number needed to harm of 75. Any intracranial hemorrhage and 90-day mortality did not differ significantly.

Key takeaways

The analysis evaluated thrombolysis initiated more than 4.5 hours after last known well in imaging-selected or otherwise trial-eligible patients.
Excellent and good functional outcomes at 90 days favored thrombolysis across the pooled evidence.
Symptomatic intracranial hemorrhage increased, although any hemorrhage and all-cause mortality were similar between groups.
The findings apply to selected trial populations and do not replace local eligibility, imaging, contraindication, or treatment protocols.

Why this matters on shift

Emergency and neurology nurses help establish last-known-well time, obtain rapid imaging and laboratory data, prepare eligible patients, and detect hemorrhagic or neurologic deterioration after treatment. The review reinforces both the potential benefit of timely extended-window evaluation and the need for close post-thrombolysis surveillance.

Bedside takeaway

Extended-window thrombolysis improved functional outcomes in selected patients but increased symptomatic intracranial hemorrhage.

Nursing implications

Activate the stroke pathway without excluding a patient solely because more than 4.5 hours have elapsed. Capture the timing and eligibility data required by the local protocol, then perform the prescribed neurologic, blood-pressure, and bleeding surveillance if thrombolysis is ordered.

Limitations & cautions

The meta-analysis combined randomized trials and individual-patient-data meta-analyses with different agents, time windows, imaging strategies, vascular territories, and use of endovascular treatment. Selection criteria were trial-specific, and pooled findings do not define eligibility or treatment for an individual patient.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Neurology (PubMed). IV Thrombolysis in the Extended Time Window for Acute Ischemic Stroke: An Updated Systematic Review and Meta-Analysis.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Critical care nursing clinics of North America (PubMed)Jun 22, 2026Systematic ReviewPractice applicable

A clinical review describes ICU nurses as central to coordinated prevention of multidrug-resistant organism transmission through stewardship, pathogen surveillance, appropriate isolation precautions, and evidence-based hygiene practices.

ICU Med-SurgAI summaryReview source

Systematic ReviewInfection ControlWorkflowPatient EducationPractice applicableAI summary · original source linked below

The review links ICU vulnerability to immunosuppression, invasive devices, broad-spectrum antimicrobial exposure, and the care environment. It emphasizes a multimodal, team-based approach rather than a single intervention, including laboratory and antibiotic stewardship, passive and active surveillance, timely use and de-escalation of precautions, and hygiene measures. The abstract does not report a systematic search or pooled patient outcomes.

Key takeaways

Critically ill patients face overlapping exposure risks related to devices, antimicrobials, immune dysfunction, and the ICU environment.
The review frames MDRO prevention as coordinated work across bedside nursing, infection prevention, laboratory, and antimicrobial-stewardship teams.
Nursing responsibilities include surveillance, hygiene, and correct implementation and de-escalation of ordered precautions.
This is a clinical review, so it does not quantify the independent effect of any single prevention measure.

Why this matters on shift

ICU nurses are continuously positioned to recognize new transmission risks, maintain device and hygiene practices, and identify when precaution or antimicrobial plans need clarification. The review supports reliable team coordination while leaving organism-specific actions to current infection-prevention guidance.

Bedside takeaway

MDRO prevention in the ICU depends on coordinated surveillance, precautions, stewardship, hygiene, and reliable bedside execution.

Nursing implications

Verify the organism-specific precaution plan at handoff, perform the approved hygiene and device-care bundle, and communicate changes in cultures, antimicrobial therapy, or isolation status. Escalate uncertainty promptly to infection prevention and the treating team.

Limitations & cautions

The PubMed abstract describes a narrative clinical review without a reported systematic search, evidence grading, sample, or pooled effect estimates. It does not establish the comparative effectiveness of specific surveillance, isolation, stewardship, or hygiene interventions, and local resistance patterns may change implementation.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Critical care nursing clinics of North America (PubMed). Infection Prevention and Control in the Intensive Care Unit: Preventing the Spread of Multi-Drug-Resistant Organisms.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Neurology (PubMed)Jul 22, 2026Systematic ReviewPractice applicable

A systematic review of 10 publications on acute MOG antibody-associated disease found that plasmapheresis was associated with favorable visual and neurologic recovery, but high heterogeneity and nonrandomized evidence prevent causal comparisons with other acute treatments.

EmergencyAI summaryReview source

Systematic ReviewResearchWorkflowPractice applicableAI summary · original source linked below

The review included 1,045 patients and 1,368 attacks; eight studies with 710 patients and 1,033 attacks contributed to meta-analysis. In optic neuritis, plasmapheresis was associated with improved visual acuity and an estimated 81% excellent-recovery rate, although the confidence interval was very wide. Good recovery was also common in attacks involving myelitis or cerebral disease, and pooled plasmapheresis-related adverse effects were 3%.

Key takeaways

Ten publications included 1,045 patients with 1,368 acute MOGAD attacks.
Eight studies contributed data for meta-analysis, including 710 patients and 1,033 attacks.
Plasmapheresis was associated with visual improvement in optic neuritis and favorable recovery in other attack presentations.
High heterogeneity, variable timing and severity, and the absence of randomized comparisons limit treatment-effect and safety conclusions.

Why this matters on shift

Neurology nurses help recognize evolving visual, motor, sensory, and cerebral symptoms, establish a pre-treatment baseline, and monitor patients during escalation therapy. The review supports careful response tracking while emphasizing that pooled observational recovery rates do not identify who should receive plasmapheresis or when.

Bedside takeaway

Plasmapheresis was associated with recovery in acute MOGAD, but nonrandomized evidence cannot define comparative benefit or optimal timing.

Nursing implications

Document the neurologic and visual baseline before treatment when feasible, follow the ordered plasmapheresis monitoring pathway, and trend the same clinical domains across exchanges. Escalate deterioration, treatment intolerance, or new symptoms promptly through the neurology and apheresis teams.

Limitations & cautions

The evidence came from heterogeneous, nonrandomized studies with differences in attack type, severity, prior treatment, plasmapheresis timing, and outcome definitions. Recovery estimates had wide intervals, confounding by treatment selection is likely, and a low pooled adverse-effect rate cannot establish comparative safety.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Neurology (PubMed). Effectiveness and Safety of Plasmapheresis in MOGAD Attacks: A Systematic Review and Meta-Analysis.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Selected patients benefited from extended-window stroke thrombolysis, with more symptomatic bleeding

ICU review centers nurses in coordinated prevention of multidrug-resistant organism spread

Plasmapheresis was linked to recovery in acute MOGAD attacks, but evidence was heterogeneous