| Summary: | The Norwegian Knowledge Centre for the Health Services (now part of the Norwegian Institute of Public Health) was commissioned to update the evidence on the effect of intravenous thrombolytic treatment administered 3 to 4.5 hours after stroke. There was already a Cochrane systematic review by Wardlaw et al. from 2014. We searched for systematic reviews published after Wardlaw's review, but found none that fulfilled the inclusion criteria. Then we searched for randomised controlled trials published later than the search date for the Cochrane review, but we found no relevant trials. We have, therefore, conveyed the findings from Wardlaw and supplemented with data from an individual patient data meta-analysis. We have also graded our confidence in the estimates of effect using the GRADE tool (Grading of Recommendations Assessment, Development and Evaluation). The outcomes are assessed 3-6 months after the stroke and are compared with placebo. We found that intravenous thrombolysis administered 3 to 4.5 hours after onset of ischemic stroke gives: 1. Uncertain effect on the outcome "alive and independent" (very low quality/confidence) 2. A positive effect on the outcome "alive with no functional impairment" (moderate quality/confidence) 3. Between 37 fewer and 36 more per 1000 in risk of death (low quality/confidence) 4. Uncertain risk of symptomatic intracranial haemorrhage (very low quality/confidence)
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