Real-World Effectiveness of Intravenous Stroke Thrombolysis is more than the Expectation of Practicing Neurologists

Abstract

Background:The objective of the study was to compare the actual results of intravenous thrombolytic therapy (IVTT) in acute ischemic stroke with results anticipated by neurologists in practice.Methods:Neurologists practicing in Thrissur metropolitan region, covering a population of 1.8 million, were telephonically surveyed about the number of yearly IVTT and their expert opinion/comment about effects of thrombolysis. This was compared with the results of IVTT from a single institution in the same region from 2012 to 2016.Results:Eight neurologists in the region give approximately 140–150 IVTT per year. Nearly 20%–40% (median 32%) patients have good outcome, 5%–10% (median 9%) have intracerebral hematoma (ICH), and 25%–35% (median 30%) have death/bad outcome. Two neurologists from a tertiary care hospital in the region treated 122 cases of ischemic strokes with IVTT from 2012 to 2016. Age ranged from 8 to 88 years and 88 were males. Average delay in reaching hospital was 138.1 min and the door-to-needle time was 56.3 min. There were 26 cases of posterior-circulation strokes and 14 cases of cardioembolic strokes. At presentation, average National Institute of Health Stroke Scale (NIHSS) was 14.7; Modified Rankin Scale (mRS) 0.4; and CT Alberta Stroke Program Early Computerized Tomography Scores was 9.5. Good and sustained benefit (GSB) (>4 reduction in NIHSS at 24 h and 7 days) was there in 49% and no improvement (NI)/worsening in 36%. mRS 0–2 at discharge/30 days was documented in 57.3%. Symptomatic ICH was 10% (12/122) and mortality rate was 11.5% (14/122). GSB in posterior circulation strokes was 69.2% and NI/worsening in only 7.7%. mRS was 0–2 in 77% of posterior circulation strokes.Conclusion:Contrary to the popular belief of the practicing neurologists, IVTT has a high percentage of good outcome with a reasonable bleeding risk and low rates of absolute futility.

Efficacy of Tirofiban Administered at Different Time Points after Intravenous Thrombolytic Therapy with Alteplase in Patients with Acute Ischemic Stroke

“…The NIHSS score in the 4 groups at different time points (prethrombolysis [T1], 7 § 1 d, 14 § 2 d, and 90 § 7 d, and post-thrombolysis [T2-4]), as well as the modified Rankin Scale (mRS) score at T4 were obtained. The proportion of patients with an NIHSS score of 0-1 point at any time point or 4 points less than the baseline score in the different groups were calculated 16,17 to evaluate the corresponding drug efficacy. The proportion of patients with mRS score of 0-2 points in the four groups at T4 18,19 were also calculated.…”