Giving clot-busting drugs beyond 4.5 hours raises bleeding risk but may improve function

Stroke survivors often face a narrow window for life-saving treatment. Most patients receive clot-busting drugs within 4.5 hours of symptom onset. But what happens to those who arrive later? A new analysis looked at giving these drugs beyond that standard time limit. The study combined data from 2,050 adults with acute ischemic stroke. Ischemic stroke means a blood clot blocks blood flow to the brain. The team compared patients who received the drug to those who did not. They tracked how people functioned after the event and whether they survived. The results were mixed. Patients who got the drug later had higher rates of functional independence and better scores on the modified Rankin Scale. This scale measures how well a person can perform daily tasks. However, the risk of symptomatic intracranial hemorrhage jumped significantly. This serious bleeding inside the skull occurred much more often in the group treated with the extended window. Mortality rates did not differ significantly between the two groups. The evidence suggests that while some patients may regain more function, the danger of severe bleeding is real. Doctors must weigh these risks carefully. The study supports using extended-window treatment only when guided by specific clinical or imaging criteria. Without such strict selection, the bleeding danger could outweigh the potential benefits for many patients.