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Science 19 September 2003:
Vol. 301. no. 5640, p. 1677
DOI: 10.1126/science.1090270
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Policy Forum

MEDICINE:
Stroke--tPA and the Clinic

John R. Marler* and Larry B. Goldstein

Clinical trial results are not always rapidly incorporated into routine medical practice. This Policy Forum describes a variety of barriers that have impeded the more widespread use of thrombolytic therapy (tPA, tissue plasminogen activator) for selected patients with acute ischemic stroke. These barriers are not insurmountable but will require a concerted effort to overcome.

J. R. Marler is associate director for Clinical Trials, National Institute of Neurological Disorders and Stroke, Bethesda, MD 20817, USA. L. B. Goldstein is with the Department of Medicine (Neurology), Duke Center for Cerebrovascular Disease, and the Stroke Policy Program, Center for Clinical Health Policy Research, Duke University and the VA Medical Center, Durham, NC 27710, USA.

*To whom correspondence should be addressed. E-mail: marlerj{at}ninds.nih.gov

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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES:
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L. Park, E. F. Gallo, J. Anrather, G. Wang, E. H. Norris, J. Paul, S. Strickland, and C. Iadecola (2008)
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J. K. T. Wang, S. Portbury, M. B. Thomas, S. Barney, D. J. Ricca, D. L. Morris, D. S. Warner, and D. C. Lo (2006)
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Endothelial targeting of a recombinant construct fusing a PECAM-1 single-chain variable antibody fragment (scFv) with prourokinase facilitates prophylactic thrombolysis in the pulmonary vasculature.
B.-S. Ding, C. Gottstein, A. Grunow, A. Kuo, K. Ganguly, S. M. Albelda, D. B. Cines, and V. R. Muzykantov (2005)
Blood 106, 4191-4198
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New Functions for an Old Enzyme: Nonhemostatic Roles for Tissue-Type Plasminogen Activator in the Central Nervous System.
M. Yepes and D. A. Lawrence (2004)
Experimental Biology and Medicine 229, 1097-1104
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Mechanisms of Hemorrhagic Transformation After Tissue Plasminogen Activator Reperfusion Therapy for Ischemic Stroke.
X. Wang, K. Tsuji, S.-R. Lee, M. Ning, K. L. Furie, A. M. Buchan, and E. H. Lo (2004)
Stroke 35, 2726-2730
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tPA and Proteolysis in the Neurovascular Unit.
E. H. Lo, J. P. Broderick, and M. A. Moskowitz (2004)
Stroke 35, 354-356
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Critical Care and Emergency Medicine Neurology.
D. F. Hanley and W. Hacke (2004)
Stroke 35, 365-366
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