Community hospitals and physicians are replicating the results obtained in clinical trials of thrombolytic therapy in patients with acute stroke. However, thrombolysis continues to reach far fewer stroke patients than the total number who might potentially benefit. Delays in initiating therapy and physician concerns about brain haemorrhage are major hindrances to increased use. New findings from the landmark US National Institute of Neurological Disorders and Stroke (NINDS) trial of alteplase [tPA, ‘Activase’] in patients with acute stroke show that treatment benefits are maintained for at least the first year after the intervention, delegates were told at the American Heart Association's 23rd Annual Joint Conference on Stroke and Cerebral Circulation [Orlando, US; February 1998].