Safety of routine IV thrombolysis between 3 and 4.5 h after ischemic stroke

被引:24
作者
Uyttenboogaart, M.
Vroomen, P. C. A. J.
Stewart, R. E.
De Keyser, J.
Luijckx, G. J.
机构
[1] Univ Groningen, Med Ctr, Dept Neurol, NL-9700 RB Groningen, Netherlands
[2] Univ Groningen, Med Ctr, Dept Hlth Sci, Groningen, Netherlands
关键词
safety; stroke; thrombolysis; time window;
D O I
10.1016/j.jns.2006.12.011
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: The administration of tissue plasminogen activator (t-PA) has been proven effective for ischemic stroke within 3 h after onset. A pooled-analysis of six trials showed that intravenous t-PA still improves outcome when given between 3 to 4.5 h after stroke onset. On the basis of this pooled analysis, t-PA was also routinely offered to our patients between 3-4.5 h. We report the safety and clinical features of this group together with the features of the group given t-PA within 3 h. Methods: Prospectively patient characteristics, stroke severity, stroke subtype, incidence of symptomatic intracerebral hemorrhage (SICH), in-hospital mortality, and 3-months modified Rankin Scale scores (mRS) were registered. Data was analyzed separately for patients treated within 3 h (early group) and those treated between 3-4.5 h (late group). Results: Among 176 patients who underwent intravenous thrombolysis, 101 were treated in the early group and 75 in the late group. Six (5.9%; 95% CI 2.8%-12.3%) patients in the early group and 4 (5.3%; 95% CI 2.2%-12.9%) in the late group developed SICH (p=1.0). In the early group 13 (12.9%; 95% CI 7.7%-20.8%) patients died within 7 days after admission, compared to 5 (6.7%; 95% CI 3.0%-14.7%) in the late group (p=0.179). In the early group 44 (43.6%; 95% CI 43.3%-53.3%) were independent (mRS <= 2) at three months, compared to 36 (48.0%; 95% CI 37.0%-59.1%) in the late group (p=0.559). Conclusion: Our data show no trend of decreased safety of thrombolysis beyond 3 h. Due to a small sample size a harmful effect cannot be excluded but seems unlikely. (c) 2006 Elsevier B.V. All rights reserved.
引用
收藏
页码:28 / 32
页数:5
相关论文
共 24 条
[1]   Intravenous tissue-type plasminogen activator for treatment of acute stroke - The standard treatment with alteplase to reverse stroke (STARS) study [J].
Albers, GW ;
Bates, VE ;
Clark, WM ;
Bell, R ;
Verro, P ;
Hamilton, SA .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2000, 283 (09) :1145-1150
[2]   CLASSIFICATION AND NATURAL-HISTORY OF CLINICALLY IDENTIFIABLE SUBTYPES OF CEREBRAL INFARCTION [J].
BAMFORD, J ;
SANDERCOCK, P ;
DENNIS, M ;
BURN, J ;
WARLOW, C .
LANCET, 1991, 337 (8756) :1521-1526
[3]   Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset - The ATLANTIS study: A randomized controlled trial [J].
Clark, WM ;
Wissman, S ;
Albers, GW ;
Jhamandas, JH ;
Madden, KP ;
Hamilton, S .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1999, 282 (21) :2019-2026
[4]   Predictors of good outcome after intravenous tPA for acute ischemic stroke [J].
Demchuk, AM ;
Tanne, D ;
Hill, MD ;
Kasner, SE ;
Hanson, S ;
Grond, M ;
Levine, SR .
NEUROLOGY, 2001, 57 (03) :474-480
[5]   Tissue plasminogen activator for acute ischemic stroke in clinical practice - A meta-analysis of safety data [J].
Graham, GD .
STROKE, 2003, 34 (12) :2847-2850
[6]   Early intravenous thrombolysis for acute ischemic stroke in a community-based approach [J].
Grond, M ;
Stenzel, C ;
Schmülling, S ;
Rudolf, J ;
Neveling, M ;
Lechleuthner, A ;
Schneweis, S ;
Heiss, WD .
STROKE, 1998, 29 (08) :1544-1549
[7]   Intravenous tissue-type plasminogen activator therapy for ischemic stroke - Houston experience 1996 to 2000 [J].
Grotta, JC ;
Burgin, WS ;
El-Mitwalli, A ;
Long, M ;
Campbell, M ;
Morgenstern, LB ;
Malkoff, M ;
Alexandrov, AV .
ARCHIVES OF NEUROLOGY, 2001, 58 (12) :2009-2013
[8]   Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II) [J].
Hacke, W ;
Kaste, M ;
Fieschi, C ;
von Kummer, R ;
Davalos, A ;
Meier, D ;
Larrue, V ;
Bluhmki, E ;
Davis, S ;
Donnan, G ;
Schneider, D ;
Diez-Tejedor, E ;
Trouillas, P .
LANCET, 1998, 352 (9136) :1245-1251
[9]  
HACKE W, 1995, JAMA-J AM MED ASSOC, V274, P1017, DOI 10.1001/jama.274.13.1017
[10]  
Hacke W, 2004, LANCET, V363, P768