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

Uyttenboogaart, M., Vroomen, P. C. A. J., Stewart, R. E., De Keyser, J. & Luijckx, G. J., 15-Mar-2007, In : JOURNAL OF THE NEUROLOGICAL SCIENCES. 254, 1-2, p. 28-32 5 p.

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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

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.

Original languageEnglish
Pages (from-to)28-32
Number of pages5
JournalJOURNAL OF THE NEUROLOGICAL SCIENCES
Volume254
Issue number1-2
Publication statusPublished - 15-Mar-2007

    Keywords

  • safety, stroke, thrombolysis, time window, TISSUE-PLASMINOGEN ACTIVATOR, INTRAVENOUS THROMBOLYSIS, CLINICAL-PRACTICE, CONTROLLED-TRIAL, THERAPY, ALTEPLASE, EXPERIENCE, ECASS, PA, PREDICTORS

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