• Kazuo Minematsu, Kazunori Toyoda, Teruyuki Hirano, Kazumi Kimura, Rei Kondo, Etsuro Mori, Jyoji Nakagawara, Nobuyuki Sakai, Yoshiaki Shiokawa, Norio Tanahashi, Masahiro Yasaka, Yasuo Katayama, Susumu Miyamoto, Akira Ogawa, Makoto Sasaki, Sadao Suga, Takenori Yamaguchi, and Japan Stroke Society.
• National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
• J Stroke Cerebrovasc Dis. 2013 Jul 1; 22 (5): 571-600.

AbstractIn Japan, intravenous alteplase, a recombinant tissue-type plasminogen activator (rt-PA), was approved for an indication of ischemic stroke in 2005 on the basis of the results of a clinical trial with a unique dose of the drug (0.6 mg/kg). The Japan Stroke Society published the guidelines for intravenous application of rt-PA and organized training sessions for proper use all over Japan in an effort to promote the safe, widespread use of intravenous alteplase. Seven years following its approval, clinical experience with intravenous alteplase has accumulated, additional evidence of intravenous alteplase has been found in Japan and overseas, and the medical environment has substantially changed, including approvals for new drugs and medical devices. Notably, the use of alteplase in the extended therapeutic time window (within 4.5 hours of symptom onset) became covered by insurance in Japan in August 2012. To address these changing situations, we have decided to prepare the revised guidelines. In preparing the second edition, we took care to make its contents more practical by emphasizing information needed in clinical practice. While the first edition was developed with emphasis on safety in light of limited clinical experience with intravenous alteplase in Japan in 2005, this second edition is a substantial revision of the first edition mainly in terms of eligibility criteria, on the basis of accumulated evidence and the clinical experience. Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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