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Stroke. 2015 Nov;46(11):3184-9. doi: 10.1161/STROKEAHA.115.010420. Epub 2015 Oct 8.

Intravenous Thrombolysis for Stroke Recurring Within 3 Months From the Previous Event.

Author information

1
From the 2nd Department of Neurology (M.K., A.K., A.C.), and Interventional Stroke and Cerebrovascular Treatment Centre (A.K.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland (A.C.); International Clinical Research Center and Neurology Department, St Anne's Hospital in Brno and Masaryk University, Brno, Czech Republic (R.M.); Neurology Department, Ostava-Vítkovice Hospital, Research and Training Institute, Ostrava Czech Republic (D.V.); Neurology Department, University Hospital Nitra, Constantin Philosopher University, Nitra, Slovakia (M.B.); Department of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovakia (Z.G.); Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Slovenia (V.Š.); Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary (L.C., K.F.); Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.); Medical Center Aviva, Zagreb, Croatia (V.D.); Department of Neurology, University Hospital "Sestre Milosrdnice", Zagreb, Croatia (V.B.-K.); Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Lithuania (A.V.); Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University and Vilnius University Hospital Santariskiu Clinics, Lithuania (D.J.); Stroke Rehabilitation and Research Center, Memorial Sisli Hospital, Memorial Health Group Stroke Center, Istanbul, Turkey (Y.K.); Department of Neurology and Neurosurgery, Pirogov Russian National Medical University, Moscow, Russia (N.S.); Department of Neurological Diseases, Faculty of Medicine, Medical University of Varna, Bulgaria (S.A.); and Department of Neurology, Karolinska University Hospital, Solna and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A., N.W.).
2
From the 2nd Department of Neurology (M.K., A.K., A.C.), and Interventional Stroke and Cerebrovascular Treatment Centre (A.K.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland (A.C.); International Clinical Research Center and Neurology Department, St Anne's Hospital in Brno and Masaryk University, Brno, Czech Republic (R.M.); Neurology Department, Ostava-Vítkovice Hospital, Research and Training Institute, Ostrava Czech Republic (D.V.); Neurology Department, University Hospital Nitra, Constantin Philosopher University, Nitra, Slovakia (M.B.); Department of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovakia (Z.G.); Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Slovenia (V.Š.); Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary (L.C., K.F.); Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.); Medical Center Aviva, Zagreb, Croatia (V.D.); Department of Neurology, University Hospital "Sestre Milosrdnice", Zagreb, Croatia (V.B.-K.); Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Lithuania (A.V.); Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University and Vilnius University Hospital Santariskiu Clinics, Lithuania (D.J.); Stroke Rehabilitation and Research Center, Memorial Sisli Hospital, Memorial Health Group Stroke Center, Istanbul, Turkey (Y.K.); Department of Neurology and Neurosurgery, Pirogov Russian National Medical University, Moscow, Russia (N.S.); Department of Neurological Diseases, Faculty of Medicine, Medical University of Varna, Bulgaria (S.A.); and Department of Neurology, Karolinska University Hospital, Solna and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A., N.W.). czlonkow

Abstract

BACKGROUND AND PURPOSE:

According to the European license, alteplase can be given no sooner than 3 months after previous stroke. However, it is not known whether past history of stroke influences the effect of treatment. Our aim was to evaluate safety and functional outcome after intravenous thrombolysis administered in everyday practice to patients with previous stroke≤3 months compared with those with first-ever stroke.

METHODS:

We analyzed consecutive cases treated with alteplase between October 2003 and July 2014 contributed to the Safe Implementation of Thrombolysis for Stroke-Eastern Europe registry from 12 countries. Odds ratios were calculated using unadjusted and adjusted logistic regression.

RESULTS:

Of 13,007 patients, 11,221 (86%) had no history of stroke and 249 (2%) experienced previous stroke≤3 months before admission. Patients with previous stroke≤3 months had a higher proportion of hypertension and hyperlipidemia. There were no significant differences in outcome, including symptomatic intracerebral hemorrhage according to European Cooperative Acute Stroke Study (unadjusted odds ratio 1.27, 95% confidence interval: 0.74-2.15), and being alive and independent at 3 months (odds ratio 0.81, 95% confidence interval: 0.61-1.09).

CONCLUSIONS:

Patients currently treated with alteplase, despite a history of previous stroke≤3 months, do not seem to achieve worse outcome than those with first-ever stroke. Although careful patient selection was probably of major importance, our findings provide reassurance that this group of patients may safely benefit from thrombolysis and should not be arbitrarily excluded as a whole. Further studies are needed to identify the shortest safe time lapse from the previous event to treatment with alteplase.

KEYWORDS:

acute stroke; alteplase; off-label use; recurrence; thrombolysis; treatment outcome

PMID:
26451024
DOI:
10.1161/STROKEAHA.115.010420
[Indexed for MEDLINE]

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