Intravenous thrombolysis in acute ischemic stroke after POLKARD: one center analysis of program impact on clinical practice (original) (raw)
Related papers
2011
Objectives-Intravenous thrombolysis was conditionally approved in the European Union (EU) in 2002, under the requirement of entering all patients into Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST). Countries not belonging to the EU by 2002, i.e. Poland were invited to enter data into the SITS International Stroke Thrombolysis Registry (SITS-ISTR). The aim of this study is to compare the safety and efficacy of thrombolysis in the Polish SITS-ISTR stroke patient population with patients registered in SITS-MOST. Methods-481 patients in Poland were reported between 2003 and 2007. Baseline and outcome data of Polish patients were compared with SITS-MOST. Results-Most of the baseline characteristics did not differ between the groups. The most important was the onset-to-needle and door-toneedle times were significantly longer in Polish patients, 150 vs 136 min and 82 vs 68 min, respectively (P < 0.001). The symptomatic intracranial haemorrhage and independence rates at 3 months were similar in both populations. Polish patients had a significantly higher 3-month mortality rate, 18.6% vs 11.3% (P < 0.001). Conclusions-Because of higher mortality the study implies the need to improve the organization of thrombolysis services and provides the rationale to continue the monitoring of treatment in Poland.
Acta Neurologica Scandinavica, 2009
Objectives-Intravenous thrombolysis was conditionally approved in the European Union (EU) in 2002, under the requirement of entering all patients into Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST). Countries not belonging to the EU by 2002, i.e. Poland were invited to enter data into the SITS International Stroke Thrombolysis Registry (SITS-ISTR). The aim of this study is to compare the safety and efficacy of thrombolysis in the Polish SITS-ISTR stroke patient population with patients registered in SITS-MOST. Methods-481 patients in Poland were reported between 2003 and 2007. Baseline and outcome data of Polish patients were compared with SITS-MOST. Results-Most of the baseline characteristics did not differ between the groups. The most important was the onset-to-needle and door-toneedle times were significantly longer in Polish patients, 150 vs 136 min and 82 vs 68 min, respectively (P < 0.001). The symptomatic intracranial haemorrhage and independence rates at 3 months were similar in both populations. Polish patients had a significantly higher 3-month mortality rate, 18.6% vs 11.3% (P < 0.001). Conclusions-Because of higher mortality the study implies the need to improve the organization of thrombolysis services and provides the rationale to continue the monitoring of treatment in Poland.
Neurologia i Neurochirurgia Polska, 2013
N Ne eu ur ro ol lo og gi ia a i i N Ne eu ur ro oc ch hi ir ru ur rg gi ia a P Po ol ls sk ka a 2013; 47, 4 310 A A b b s s t t r r a a c c t t B Ba ac ck kg gr ro ou un nd d a an nd d p pu ur rp po os se e: : Ongoing evaluation of the results of thrombolytic therapy in patients with ischaemic stroke (IS) in regions with different health care organization is absolutely crucial for making this method of treatment safer and efficient. The aim of this study was to analyse the efficacy and safety of treatment with intravenous alteplase in patients with acute IS in a rural hospital. M Ma at te er ri ia al l a an nd d m me et th ho od ds s: : Between 2006 and 2011, 1392 patients with IS were treated (including 200 patients treated with alteplase; 14.37%).
Journal of Intellectual Disability - Diagnosis and Treatment, 2020
Background and Objective: Although current evidence has demonstrated the efficacy and immunity of Alteplase, further studies are needed to evaluate its functioning in the therapeutic system. This study aims to assess the effect and immunity of tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke (AIS). Methods: This study was conducted as a retrospective observational study on patients with AIS referred to Ahvaz Golestan Hospital in 2017-2018. By using the hospital database, demographic information, the cause of lack of thrombolytic therapy, the onset of symptoms and admission were extracted. The National Institutes of Health Stroke Scale (NIHSS) at the time of referral, 24 hours after treatment, and at the time of discharge, the modified Rankin Scale (mRS) scores at discharge time and 3 months after discharge, complications and mortality at the time of admission and 3 months after discharge were recorded. Results: The mean of the event to needle (hrs) was significantly lower in the tPA group (P <0.0001), and delay in visiting time and loss of golden time were of the main reasons for not receiving tPA in the control group. The mean difference and the decrease in NIHSS score 24 hours after admission and discharge in the tPA group was significantly higher (P <0.0001). At the time of discharge, the mean score of mRS in the two groups was not significantly different. Three months after treatment, the mean score of mRS in the tPA group was significantly lower than that in the control group (P <0.05). The percentage of patients with bleeding complications was higher in the tPA group (7.27%) than that in the control group (4.89%). The percentage of deaths during the hospital stay in the tPA group (3.64%) was higher than that in the control group (1.63%). Conclusion: Patients with AIS under intravenous thrombolytic therapy with tPA showed improvement in functional measurements and neurological outcomes compared with the control group. Lack of significant difference in the rate of complications and mortality between the two groups indicated the safety and high efficacy of thrombolytic therapy in patients with AIS.
Off-Label Thrombolysis Is Not Associated With Poor Outcome in Patients With Stroke
Stroke, 2010
Background and Purpose-Numerous contraindications included in the license of alteplase, most of which are not based on scientific evidence, restrict the portion of patients with acute ischemic stroke eligible for treatment with alteplase. We studied whether off-label thrombolysis was associated with poorer outcome or increased rates of symptomatic intracerebral hemorrhage compared with on-label use. Methods-All consecutive patients with stroke treated with intravenous thrombolysis from 1995 to 2008 at the Helsinki University Central Hospital were registered (nϭ1104). After excluding basilar artery occlusions (nϭ119), the study population included 985 patients. Clinical outcome (modified Rankin Scale 0 to 2 versus 3 to 6) and symptomatic intracerebral hemorrhage according to 3 earlier published criteria were analyzed with a logistic regression model adjusting for 21 baseline variables. Results-One or more license contraindications to thrombolysis was present in 51% of our patients (nϭ499). The most common of these were age Ͼ80 years (nϭ159), mild stroke National Institutes of Health Stroke Scale score Ͻ5 (nϭ129), use of intravenous antihypertensives prior to treatment (nϭ112), symptom-to-needle time Ͼ3 hours (nϭ95), blood pressure Ͼ185/110 mm Hg (nϭ47), and oral anticoagulation (nϭ39). Age Ͼ80 years was the only contraindication independently associated with poor outcome (OR, 2.18; 95% CI, 1.27 to 3.73) in the multivariate model. None of the contraindications were associated with an increased risk of symptomatic intracerebral hemorrhage. Conclusions-Off-license thrombolysis was not associated with poorer clinical outcome, except for age Ͼ80 years, nor with increased rates of symptomatic intracerebral hemorrhage. The current extensive list of contraindications should be re-evaluated when data from ongoing randomized trials and observational studies become available. (Stroke. 2010;41:1450-1458.)
Therapeutic Advances in Neurological Disorders, 2018
Background: Intravenous thrombolysis (IVT) remains the only approved systemic reperfusion treatment for acute ischemic stroke (AIS), however there are scarce data regarding outcomes and complications of IVT in Greece. We evaluated safety and efficacy outcomes of IVT for AIS in Greece using the Safe Implementation of Thrombolysis in Stroke: International Stroke Thrombolysis Register (SITS-ISTR) dataset. Methods: All AIS patients treated with IVT in Greece between December 2002 and July 2017 and recorded in the SITS-ISTR were evaluated. Demographics, risk factors, baseline stroke severity [defined using National Institutes of Health Stroke Scale (NIHSS)], and onset-to-treatment time (OTT) were recorded. Safety outcomes included symptomatic intracranial hemorrhage (sICH) and 3-month mortality rates. The efficacy outcomes evaluated a reduction in baseline NIHSS score at 2 and 24 h following IVT onset, 3-month favorable functional outcome [FFO; modified Rankin scale (mRS) scores of 0–1] ...