Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly?

Details

Serval ID
serval:BIB_6EC6A8421FA0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Ultra-early intravenous stroke thrombolysis: do all patients benefit similarly?
Journal
Stroke
Author(s)
Strbian D., Ringleb P., Michel P., Breuer L., Ollikainen J., Murao K., Seiffge D.J., Jung S., Obach V., Weder B., Eskandari A., Gensicke H., Chamorro A., Mattle H.P., Engelter S., Leys D., Numminen H., Köhrmann M., Hacke W., Tatlisumak T.
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
2013
Volume
44
Number
10
Pages
2913-2916
Language
english
Notes
Publication types: Journal ArticlePublication Status: ppublish. PDF type: Brief report
Abstract
BACKGROUND AND PURPOSE: 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.
METHODS: 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.
RESULTS: In the whole cohort (n=6856), shorter onset-to-treatment time as a continuous variable was significantly associated with excellent outcome (P<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; P=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; P=0.99) and baseline National Institutes of Health Stroke Scale 0 to 6 (odds ratio, 1.04; 95% confidence interval, 0.78-1.39; P=0.80). In the latter, however, an independent association (odds ratio, 1.51; 95% confidence interval, 1.14-2.01; P<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.
CONCLUSIONS: 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.
Pubmed
Web of science
Open Access
Yes
Create date
01/11/2013 20:55
Last modification date
20/08/2019 14:27
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