{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:12:40Z","timestamp":1788541960183,"version":"build-2803163510"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100002855","name":"Ministry of Science and Technology of the People\u2019s Republic of China","doi-asserted-by":"crossref","award":["2022YFC2504904"],"award-info":[{"award-number":["2022YFC2504904"]}],"id":[{"id":"10.13039\/501100002855","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Beijing Municipal Committee of Science and Technology","award":["Z211100002921064"],"award-info":[{"award-number":["Z211100002921064"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurol. Res. Pract."],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence for alteplase 4.5\u201324\u00a0h after acute ischemic stroke (AIS) onset remains limited in routine practice. We examined associations between late-window intravenous thrombolysis (IVT) and discharge outcomes in selected patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed China Stroke Center Alliance patients arriving 4\u201323.5\u00a0h after onset. Alteplase-treated patients were matched 1:1 to non-IVT patients using propensity scores. The primary outcome was modified Rankin Scale (mRS) 0\u20131 at discharge. Secondary and safety outcomes included mRS 0\u20132, registry-recorded in-hospital intracranial hemorrhage (ICH), mortality, discharge against medical advice (DAMA), and mortality or DAMA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 137,157 eligible AIS patients, 874 received IVT and were matched to 874 non-IVT patients. Median onset-to-needle time was 6.05\u00a0h (interquartile range 5.12\u201310.04); 48.4%, 23.7%, 6.6%, and 21.3% were treated at 4.5-&lt;6, 6-&lt;9, 9-&lt;12, and 12\u201324\u00a0h, respectively. IVT was associated with higher rates of mRS 0\u20131 (30.4% vs. 17.0%, odds ratio [OR] 2.14, 95% confidence interval [CI], 1.70\u20132.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and mRS 0\u20132 (65.4% vs. 58.1%; OR, 1.36; 95% CI, 1.12\u20131.66,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). In-hospital ICH was more frequent (1.7% vs. 0.6%, OR 3.04, 95% CI, 1.10\u20138.39,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03), whereas DAMA was less frequent (5.7% vs. 8.8%, OR 0.63, 95% CI, 0.44\u20130.92,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). Length of hospital stay, mortality, and mortality or DAMA did not differ significantly.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Late-window alteplase was associated with better discharge function but more registry-recorded ICH in selected patients. Because symptomatic status, hemorrhage subtype, severity, and fatality were unavailable, hemorrhagic safety remains incompletely characterized. These observational findings require cautious interpretation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s42466-026-00529-w","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T16:17:07Z","timestamp":1788538627000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Discharge outcomes of intravenous alteplase 4.5\u201324\u00a0hours after symptom onset in selected patients with acute ischemic stroke: a propensity score\u2013matched real-world study"],"prefix":"10.1186","volume":"8","author":[{"given":"Lingshe","family":"Meng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinfeng","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingyu","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aichun","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuting","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiyue","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zihan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunjuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"issue":"24","key":"529_CR1","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1056\/NEJM199512143332401","volume":"333","author":"National Institute of Neurological D","year":"1995","unstructured":"National Institute of Neurological D, Stroke rt PASSG. 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The present analysis used de-identified registry data and was approved by the Ethics Committee of Beijing Tiantan Hospital.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All authors contributed directly to the writing and critical revision of the work, and no external funding or support was received for any form of manuscript preparation.","order":2,"name":"Ethics","label":"Medical writing, editorial, and other assistance","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":3,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"74"}}