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One-year follow-Up in acute stroke patients treated with rtPA in clinical routine
S Schmülling1, M Grond, J Rudolf
1Klinik und Poliklinik für Neurologie der Universität zu Köln, Germany.
Insights
Systemic thrombolysis with alteplase in acute ischemic stroke patients achieved 1-year outcomes comparable to clinical trials when following American Heart Association guidelines. This supports routine use in clinical practice.
Area of Science:
- Neurology
- Cardiovascular Medicine
- Emergency Medicine
Background:
- A prior placebo-controlled study demonstrated a sustained 1-year benefit from systemic thrombolysis for acute ischemic stroke.
- Current management guidelines exist for acute ischemic stroke treatment.
Purpose of the Study:
- To evaluate if outcomes from systemic thrombolysis for acute ischemic stroke align with clinical trial results in a real-world setting.
- To determine if adherence to current management guidelines yields comparable results in everyday practice.
Main Methods:
- 150 consecutive acute ischemic stroke patients received alteplase systemic thrombolysis between March 1996 and July 1998.
- Treatment strictly followed American Heart Association (AHA) guidelines.
- Patients were followed for 12 months post-treatment.
Main Results:
- Patient characteristics and complication rates were similar to the National Institute of Neurological Disorders and Stroke (NINDS) study.
- At 1 year, 41% of patients had minimal or no disability (modified Rankin Scale score 0-1), mirroring the NINDS rtPA group.
- The 1-year rates for recurrent stroke and transient ischemic attack were 6.6% and 3.3%, respectively. Mortality after 3 months was 4%, unrelated to recurrent stroke.
Conclusions:
- The findings support the routine administration of recombinant tissue plasminogen activator (rtPA) for acute ischemic stroke.
- Strict adherence to AHA guidelines is crucial for achieving comparable outcomes in clinical practice.
Background And Purpose:
A recent placebo-controlled study provided evidence of a sustained benefit at 1 year from systemic thrombolysis in patients with acute ischemic stroke. The scope of the present study is to determine whether comparable results may be attained in everyday practice if current management guidelines are closely met.
Methods:
Between March 1996 and July 1998, 150 consecutive patients with acute ischemic stroke were treated with systemic thrombolysis using alteplase, strictly in accordance with American Heart Association (AHA) guidelines. The patients were followed up for 12 months after treatment.
Results:
Baseline characteristics and complication rates were comparable to those of the National Institute of Neurological Disorders and Stroke (NINDS) study, except for a somewhat younger age (mean 63 years) and lower National Institutes of Health Stroke Scale score (median 11). At 1 year, 41% of our patients showed minimal or no disability (Rankin scale score of 0 or 1), comparable to 41% in the NINDS rtPA group. The overall rate of recurrent stroke was 6.6% and the transient ischemic attack rate 3.3% at 1 year. Six patients (4%) died after the first 3 months, none of them due to recurrent stroke, and 5 had already been severely disabled at 3 months.
Conclusions:
These observations further encourage the routine use of rtPA for the treatment of acute ischemic stroke in strict accordance with the AHA guidelines.