Systemic thrombolysis in clinical practice: what have we learned after the Safe Implementation of Thrombolysis in Stroke Monitoring Study?

Abstract

The Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS-MOST) of 6,483 patients treated with intravenous alteplase within 3 h after stroke onset showed that this treatment was as safe and as effective in clinical practice as in randomized controlled trials. SITS-MOST was based on the SITS registry, available over a secure Internet connection. The SITS registry today includes over 22,000 treatment files on intravenous thrombolysis with an inclusion rate of 1,200-1,300 new files every 4 months. SITS now opens for other interventions than intravenous thrombolysis and will soon be available as an optional general stroke register. After SITS-MOST, the registry is generating new information on outcome predictors, treatments in patients in later time windows, patients with hyperdense middle cerebral artery signs, and several publications are in preparation. Important information is currently collected on the effect on door-to-needle time and safety of a broad implementation of thrombolysis in a later time window.