The efficacy and safety of intravenous thrombolysis with alteplase in the treatment of ischaemic stroke in a rural hospital

Sobolewski, Piotr; Śledzińska-Dźwigał, Monika; Szczuchniak, Wiktor; Hatalska-Zerebiec, Renata; Grzesik, Marcin; Sobota, Anna

doi:10.5114/ninp.2013.36755

Cited by 5 publications

(8 citation statements)

References 27 publications

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“…The authors suggested that functioning after first week, supplemented by initial stroke severity and history information of congestive heart failure, may provide an early outcome guide useful for more intensive and efficient secondary prevention [28]. Disability and mortality at day 90 was also proven to be connected with baseline NIHSS score in other studies [7,22]. We obtained similar results regarding baseline NIHSS score.…”

Section: Discussionsupporting

confidence: 76%

“…We showed that patients with the presence of old ischaemic changes in the initial brain CT were less likely to gain 24-hour neurological improvement. The role of such findings is not clear, but similar results were presented by other authors -the presence of radiological signs of previous stroke in baseline CT was connected with higher rate of death within 3 months of thrombolysis [7]. This is presumably connected with the presence of evident or clinically silent cerebrovascular disorders in such patients, similarly to the interpretation of white matter hyperintensities [30].…”

Section: Discussionsupporting

confidence: 54%

“…Rt-PA decreases the relative risk of death or disability after 3 months by 13%. The recommended therapeutic window is 4.5 h after stroke onset [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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The early outcome of thrombolytic treatment in ischaemic stroke patients: a retrospective analysis

Kotlęga¹,

Meller²,

Gołąb-Janowska³

et al. 2019

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Introduction: The results of early outcome in thrombolysed stroke patients are connected with the long-term effect measured as disability and death rate. There are different definitions of the early improvement in such patients. Aim of the research: To establish potential prognostic factors adversely influencing the early outcome of stroke patients treated with alteplase. Material and methods: The analysis of 245 consecutive ischaemic stroke patients treated intravenously with recombinant tissue plasminogen activator (rt-PA) was conducted. The outcome was analysed 24 h after rt-PA treatment depending on the NIHSS score. Group I consisted of 105 patients with the improvement in NIHSS ≥ 2 points 24 h after intravenous rt-PA administration, and group II comprised of the rest of the patients (n = 140). Results: The independent factors adversely affecting the early outcome were: hypertension, old ischaemic lesions in initial brain computed tomography (CT), longer therapeutic window, higher baseline NIHSS (respectively: OR = 0.34, p < 0.05; OR = 0.55, p < 0.01; OR = 0.99, p < 0.01; OR = 0.91, p < 0.01). Conclusions: There are factors affecting the grade of early neurological improvement assessed 24 h after rt-PA therapy that may help to improve the efficacy of the acute phase treatment and secondary prevention of stroke patients. More attention should be paid to patients with hypertension, those with greater initial neurological deficit, longer onset-to-treatment time, and old ischaemic changes in initial brain CT. Streszczenie Wprowadzenie: Wyniki wczesnego leczenia trombolitycznego pacjentów z udarem niedokrwiennym mózgu wiążą się z długotrwałym efektem w zakresie niepełnosprawności i śmiertelności. Spotykane są różne definicje wczesnej poprawy w tej grupie pacjentów. Cel pracy: Ustalenie potencjalnych czynników prognostycznych niekorzystnie wpływających na wczesny wynik leczenia alteplazą pacjentów z udarem mózgu. Materiał i metody: Analizie poddano 245 kolejnych pacjentów z rozpoznaniem udaru niedokrwiennego mózgu leczonych dożylnie rekombinowanym tkankowym aktywatorem plazminogenu (rt-PA). Wynik oceniono 24 godziny po zastosowaniu leczenia w zależności od wyniku wg skali NIHSS. Grupę I stanowiło 105 pacjentów ze stopniem poprawy ≥ 2 pkt wg skali NIHSS w czasie 24 godzin po leczeniu, a grupę II-pozostali pacjenci (n = 140). Wyniki: Niezależnymi czynnikami ryzyka niekorzystnie wpływającymi na wczesny wynik leczenia są: nadciśnienie tętnicze, stare zmiany niedokrwienne mózgu, dłuższe okno terapeutyczne, wyższy wyjściowo wynik wg skali NIHSS (odpowiednio: OR = 0,34, p < 0,05; OR = 0,55, p < 0,01; OR = 0,99, p < 0,01; OR = 0,91, p < 0,01). Wnioski: Znane są czynniki, które wpływają na stopień wczesnej poprawy neurologicznej ocenianej w czasie 24 godzin po leczeniu trombolitycznym. Mogą one pomóc w poprawie skuteczności terapii ostrej fazy i profilaktyki wtórnej u pacjentów z udarem niedokrwiennym mózgu. Należy poświęcać więcej uwagi pacjentom z nadciśnieniem tętniczym, wyjściowo większym deficytem neurologicznym, z dłu...

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Section: Discussionsupporting

confidence: 76%

Section: Discussionsupporting

confidence: 54%

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The early outcome of thrombolytic treatment in ischaemic stroke patients: a retrospective analysis

Kotlęga¹,

Meller²,

Gołąb-Janowska³

et al. 2019

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“…Among the Class III observational studies, there was wide variability in baseline stroke severity (mean NIHSS scores ranged from 5 to 17), making comparisons difficult. 33,36,37,39,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] …”

Section: Potential Benefitsmentioning

confidence: 99%

“…25 Among other Class III studies, 33,36,37,41,44,50,55,56,58,61,66,[68][69][70][71][72][73][74][75][76][77] the prevalences of sICH associated with IV tPA administration within 4.5 hours ranged from 3% to 8% when based on the NINDS definition, whereas the prevalence was lower (2% to 6%) for those studies using an sICH definition requiring a change of 4 or more on the NIHSS. 39,53,54,57,60,[62][63][64][65]67,[78][79][80][81][82][83][84] …”

Section: Potential Harmsmentioning

confidence: 99%

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Brown¹,

Burton²,

Nazarian³

et al. 2015

Annals of Emergency Medicine

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Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis

Zeng

et al. 2019

Postgraduate Medical Journal

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ObjectivesThe National Institute of Health Stroke Scale (NIHSS) is a predictor for the prognosis of acute ischaemic stroke (AIS) and its prediction is time-dependent. We examined the performance of NIHSS at different timepoints in predicting functional outcome of patients with thrombolysed AIS.MethodsThis prospective study included 269 patients with AIS treated with recombinant tissue plasminogen activator (rt-PA). Unfavourable functional outcome was defined as modified Rankin Scale score 4–6 at 3 months after rt-PA treatment. Receiver operating characteristic curves were used to examine the predictive power of NIHSS score at admission and 2 hours/24 hours/7 days/10 days after rt-PA treatment. Youden’s index was used to select the threshold of NIHSS score. Logistic regression was used to estimate the ORs of unfavourable functional outcome for patients with NIHSS score higher than the selected thresholds.ResultsThe threshold of NIHSS score at admission was 12 (sensitivity: 0.51, specificity: 0.84) with an acceptable predictive power (area under curve [AUC] 0.74) for unfavourable functional outcome. The threshold changed to 5 at 24 hours after rt-PA treatment (sensitivity: 0.83, specificity: 0.65) and remained unchanged afterwards. The predictive power and sensitivity sequentially increased over time and peaked at 10 days after rt-PA treatment (AUC 0.92, sensitivity: 0.85, specificity: 0.80). NIHSS scores higher than the thresholds were associated with elevated risk of unfavourable functional outcome at all timepoints (all p<0.001).ConclusionsNIHSS is time-dependent in predicting AIS prognosis with increasing predictive power over time. Since patients whose NIHSS score ≥ 12 are likely to have unfavourable functional outcome with rt-PA treatment only, mechanical thrombectomy should be largely taken into consideration for these patients.

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The efficacy and safety of intravenous thrombolysis with alteplase in the treatment of ischaemic stroke in a rural hospital

Abstract: The indications for intravenous thrombolysis in patients with IS should be strictly analysed so that the treatment is effective and safe especially in older patients, patients with greater severity of neurological symptoms and patients with old post-stroke lesions in baseline CT.

Cited by 5 publications

References 27 publications

The early outcome of thrombolytic treatment in ischaemic stroke patients: a retrospective analysis

The early outcome of thrombolytic treatment in ischaemic stroke patients: a retrospective analysis

Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department

Time-dependence of NIHSS in predicting functional outcome of patients with acute ischemic stroke treated with intravenous thrombolysis

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