{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T23:45:54Z","timestamp":1789602354466,"version":"build-2803163510"},"reference-count":19,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2019,10,26]],"date-time":"2019-10-26T00:00:00Z","timestamp":1572048000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100003197","name":"Agenzia Italiana del Farmaco","doi-asserted-by":"crossref","award":["FARM65KNKY"],"award-info":[{"award-number":["FARM65KNKY"]}],"id":[{"id":"10.13039\/501100003197","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Stroke"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Since its approval, the use of alteplase had been limited to patients aged \u226480 years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>TESPI trial had been designed to evaluate whether alteplase treatment within 3\u2009h in patients with acute ischemic stroke aged &gt;80 years resulted in favorable benefit\/risk ratio compared with standard care. The meta-analysis of randomized controlled trials was updated to put findings in the context of all available evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>TESPI was a multicenter, open-label with blinded outcome evaluation, randomized, controlled trial. Main clinical endpoints were 90-day favorable functional outcome (mRS score 0\u20132) and mortality and symptomatic intracerebral hemorrhage. The trial was prematurely terminated for ethical reasons after publication of IST-3 trial which provided evidence of treatment benefit in elderly.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the planned 600 patients, 191 (88 assigned to alteplase) were enrolled. Overall, 24\/83 (28.9%) alteplase patients had a favorable outcome compared to 22\/95 (23.2%) controls (non-significant absolute difference of 5.7% for alteplase; OR 1.35, 95% CI 0.69\u20132.64, P\u2009=\u20090.381). Rates of death were non-significantly lower in the alteplase patients (18.1% vs. 26.5%); rates of symptomatic intracerebral hemorrhage were similar between the two groups (5.9% vs. 5.1%). The updated meta-analysis showed consistent results with prior estimates and add weights.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The effects of alteplase observed in this interrupted trial did not reach statistical significance, probably for the small numbers, but are consistent with and add weight to the sum total of the randomized evidence demonstrating that alteplase is beneficial in patients with acute ischemic stroke aged over 80 years, particularly if given within 3\u2009h.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1747493019884525","type":"journal-article","created":{"date-parts":[[2019,10,26]],"date-time":"2019-10-26T09:25:04Z","timestamp":1572081904000},"page":"43-54","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Thrombolysis in elderly stroke patients in Italy (TESPI) trial and updated meta-analysis of randomized controlled trials"],"prefix":"10.1177","volume":"16","author":[{"given":"Svetlana","family":"Lorenzano","sequence":"first","affiliation":[{"name":"Emergency Department Stroke Unit, Department of Human Neurosciences, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarita","family":"Vestri","sequence":"additional","affiliation":[{"name":"Department of Public Health and Infectious Disease, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Lancia","sequence":"additional","affiliation":[{"name":"Department of Biology, University of Rome, Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Bovi","sequence":"additional","affiliation":[{"name":"University Hospital, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Cappellari","sequence":"additional","affiliation":[{"name":"University Hospital, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Stanzione","sequence":"additional","affiliation":[{"name":"Policlinico Tor Vergata Hospital, University of Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Sam\u00e0","sequence":"additional","affiliation":[{"name":"Policlinico Tor Vergata Hospital, University of Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Bruscoli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, S. Maria Annunziata Hospital, Florence, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Cavazzuti","sequence":"additional","affiliation":[{"name":"Stroke Unit, Ospedale Civile S.Agostino-Estense, University Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Zini","sequence":"additional","affiliation":[{"name":"Stroke Unit, Ospedale Civile S.Agostino-Estense, University Modena Hospital, University of Modena and Reggio Emilia, Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizia","family":"Rasura","sequence":"additional","affiliation":[{"name":"S. Andrea Hospital, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Beccia","sequence":"additional","affiliation":[{"name":"S. Andrea Hospital, Sapienza University of Rome, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Comi","sequence":"additional","affiliation":[{"name":"Scientific Institute S. Raffaele, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Sessa","sequence":"additional","affiliation":[{"name":"Scientific Institute S. Raffaele, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Gandolfo","sequence":"additional","affiliation":[{"name":"University of Genova, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio","family":"Balestrino","sequence":"additional","affiliation":[{"name":"University of Genova, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Agnelli","sequence":"additional","affiliation":[{"name":"S. 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