Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy

Heuschmann, PU; Kolominsky-Rabas, Peter; Roether, J

doi:10.1016/j.accreview.2004.12.031

Cited by 20 publications

(25 citation statements)

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“…Nevertheless, the approach towards treating elderly people with rt-PA is still not consistent. For example, in the US study, in patients aged .80 years, there were comparable outcomes and no increase in haemorrhage risk versus patients ,80 years, but in the study by Heuschmann et al 16 those .75 years were more likely to have an intracranial haemorrhage than those ,55 years (10.3% v 4.9%). 15 16 In our study, three women aged 80, 81 and 83 years were treated.…”

Section: Discussionmentioning

confidence: 85%

Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated

Kobayashi

Skowronska

Litwin

et al. 2007

Emergency Medicine Journal

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Objectives: To determine the eligibility of patients with ischaemic stroke admitted to the 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland, for intravenous thrombolysis; to identify the major exclusions and assess whether organisational changes in the in-hospital stroke pathway and informative campaign in the local community and medical services can increase the number of patients treated; and to establish whether lack of previous experience with thrombolytic treatment or trials is predictive of the low proportion of patients treated. Methods: A survey of the database of patients with stroke admitted during the first 30 months after the introduction of intravenous thrombolysis for acute ischaemic stroke was conducted to search for all eligible patients. This included patients admitted within 2 h of symptom onset (assuming a 1 h door-to-needle time), age ,80 years, National Institute of Health Stroke Scale (NIHSS) Score of 5-22, seizures at onset, platelet count .100 000/ml, glycaemia 50-400 mg/dl and international normalised ratio (INR) ,1.6. The number of eligible patients was compared with the number actually treated. Results: 745 patients with acute ischaemic stroke were admitted during the study period. 18.4% were admitted within 2 h of symptom onset, 71% were aged ,80 years, 55.4% had an NIHSS score between 5 and 22, 96.1% had INR ,1.6, 98.9% had a platelet count .100 000/ml, 99.4% had blood glucose concentrations of 50-400 mg/dl and 97.4% had no seizures at onset. After adjusting for all inclusion criteria, 7.1% of the patients were found to be potentially eligible and 8.7% were actually treated (p = 0.25). Of the 65 treated patients, 63.1% were independent after 3 months, 16.9% died and none had a symptomatic intracranial haemorrhage. Conclusions: The proportion of patients with ischaemic stroke treated with intravenous thrombolysis in a previously inexperienced centre was not lower than in other centres and in countries where this treatment has been provided for a longer period of time. The number of patients treated was higher than that estimated mainly owing to organisational changes introduced in our centre, allowing treatment of those admitted between 2 and 3 h after symptom onset.

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Section: Discussionmentioning

confidence: 85%

Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated

Kobayashi

Skowronska

Litwin

et al. 2007

Emergency Medicine Journal

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“…16 17 A recent study on inhospital mortality in patients treated with tPA showed that the rate of ICH after using tPA increased with age from 4.9% in patients ,55 years to 10.3% in patients aged >75 years. 18 Two case series on the use of tPA treatment in patients aged >80 years reported a risk of ICH between 10% and 13%. 19 20 These smaller observational studies have led to a fear in using thrombolytic treatment in these patients.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study

Sylaja

Côté²,

Buchan³

et al. 2006

Journal of Neurology, Neurosurgery & Psychiatry

152

114

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Background: The benefit of intravenous tissue plasminogen activator (tPA) given within 3 h of acute ischaemic stroke to patients over 80 years of age is uncertain. Aim: To examine the clinical characteristics and complications and the predictors of outcome after intravenous tPA treatment in patients aged >80 years. Methods: Data (n = 1135) prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study were reviewed and patients aged >80 years (n = 270) treated with intravenous tPA for acute ischaemic stroke were compared with those aged ,80 years (n = 865). Results: The risk of symptomatic intracerebral haemorrhage did not differ between patients aged >80 years and ,80 years (4.4% (95% CI 2.3 to 7.6) v 4.6% (95% CI 3.3 to 6.2), p = 1.0). Favourable outcome, defined as a modified Rankin Score of 0-1 at 90 days, was seen in 26% of patients aged >80 years and in 40% of those ,80 (p,0.001). The following baseline characteristics were found to be more common in those aged >80 years than in those aged ,80 years: atrial fibrillation (37% v 18%; p,0.001); congestive heart failure (11% v 6%; p = 0.004); hypertension (59% v 48%; p = 0.002); and severity of stroke with a median National Institutes of Health Stroke Scale (NIHSS) score of 16 v 14 (p = 0.004). In the multivariable logistic regression analysis, age >80 years, stroke severity, baseline Alberta Stroke Program Early CT Score and glucose level were found to be the major independent predictors of outcome. Conclusion: In carefully selected elderly patients, the use of intravenous tPA was not found to be associated with an increased risk of symptomatic intracerebral haemorrhage. Age-related differences were seen in the clinical characteristics and outcome in the elderly population.

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“…2 The authors come to a divergent conclusion that the observed rates are similar to the rates reported from prospective trials and large observational studies 3,5 and that thrombolysis has a safety profile similar to that observed in large clinical trials. 2 The authors come to a divergent conclusion that the observed rates are similar to the rates reported from prospective trials and large observational studies 3,5 and that thrombolysis has a safety profile similar to that observed in large clinical trials.…”

Section: Mortality Of Stroke Patients Treated With Thrombolysis: Analmentioning

confidence: 77%

Sodium valproate vs phenytoin in status epilepticus: A pilot study

Rossetti¹,

Misra²,

Kalita³

et al. 2007

Neurology

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Predictors of in-hospital mortality in patients with acute ischemic stroke treated with thrombolytic therapy

Cited by 20 publications

References 0 publications

Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated

Lack of experience of intravenous thrombolysis for acute ischaemic stroke does not influence the proportion of patients treated

Thrombolysis in patients older than 80 years with acute ischaemic stroke: Canadian Alteplase for Stroke Effectiveness Study

Sodium valproate vs phenytoin in status epilepticus: A pilot study

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