Ultra-Early Intravenous Stroke Thrombolysis : Do All Patients Benefit Similarly?

Media type: E-Article
Title: Ultra-Early Intravenous Stroke Thrombolysis : Do All Patients Benefit Similarly? : Do All Patients Benefit Similarly?
Contributor: Strbian, Daniel; Ringleb, Peter; Michel, Patrik; Breuer, Lorenz; Ollikainen, Jyrki; Murao, Kei; Seiffge, David J.; Jung, Simon; Obach, Victor; Weder, Bruno; Eskandari, Ashraf; Gensicke, Henrik; Chamorro, Angel; Mattle, Heinrich P.; Engelter, Stefan; Leys, Didier; Numminen, Heikki; Köhrmann, Martin; Hacke, Werner; Tatlisumak, Turgut
imprint: Ovid Technologies (Wolters Kluwer Health), 2013
Published in: Stroke
Language: English
DOI: 10.1161/strokeaha.111.000819
ISSN: 0039-2499; 1524-4628
Keywords: Advanced and Specialized Nursing ; Cardiology and Cardiovascular Medicine ; Neurology (clinical)
Origination:
Footnote:
Description: <jats:sec> <jats:title>Background and Purpose—</jats:title> <jats:p>We previously reported increased benefit and reduced mortality after ultra-early stroke thrombolysis in a single center. We now explored in a large multicenter cohort whether extra benefit of treatment within 90 minutes from symptom onset is uniform across predefined stroke severity subgroups, as compared with later thrombolysis.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods—</jats:title> <jats:p>Prospectively collected data of consecutive ischemic stroke patients who received IV thrombolysis in 10 European stroke centers were merged. Logistic regression tested association between treatment delays, as well as excellent 3-month outcome (modified Rankin scale, 0–1), and mortality. The association was tested separately in tertiles of baseline National Institutes of Health Stroke Scale.</jats:p> </jats:sec> <jats:sec> <jats:title>Results—</jats:title> <jats:p> In the whole cohort (n=6856), shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome ( <jats:italic>P</jats:italic> <0.001). Every fifth patient had onset-to-treatment time≤90 minutes, and these patients had lower frequency of intracranial hemorrhage. After adjusting for age, sex, admission glucose level, and year of treatment, onset-to-treatment time≤90 minutes was associated with excellent outcome in patients with National Institutes of Health Stroke Scale 7 to 12 (odds ratio, 1.37; 95% confidence interval, 1.11–1.70; <jats:italic>P</jats:italic> =0.004), but not in patients with baseline National Institutes of Health Stroke Scale>12 (odds ratio, 1.00; 95% confidence interval, 0.76–1.32; <jats:italic>P</jats:italic> =0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78–1.39; <jats:italic>P</jats:italic> =0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14–2.01; <jats:italic>P</jats:italic> <0.01) was found when considering modified Rankin scale 0 as outcome (to overcome the possible ceiling effect from spontaneous better prognosis of patients with mild symptoms). Ultra-early treatment was not associated with mortality. </jats:p> </jats:sec> <jats:sec> <jats:title>Conclusions—</jats:title> <jats:p>IV thrombolysis within 90 minutes is, compared with later thrombolysis, strongly and independently associated with excellent outcome in patients with moderate and mild stroke severity.</jats:p> </jats:sec>
Access State: Open Access

Search in field:

Recently searched for: