R1--systemic thrombolysis in German stroke units--the experience from the German Stroke data bank.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Public Health

Background:

• Systemic thrombolysis with tissue plasminogen activator (t-PA) for acute ischemic stroke was approved in Germany in 2000.
• Limited data exists on t-PA use outside controlled trials, necessitating real-world evidence.
• This study evaluated t-PA application frequency, complications, and patient outcomes in German stroke centers.

Purpose of the Study:

• To determine the frequency of t-PA administration in routine clinical practice.
• To assess complications associated with systemic thrombolysis.
• To evaluate patient outcomes after t-PA treatment in specialized stroke centers.

Main Methods:

• Prospective documentation of 6234 ischemic stroke patients across 20 stroke centers (1998-1999).
• Centralized follow-up via telephone at 3 months and 1 year.
• Assessment of global functional outcome using the Modified Rankin Scale (mRS).

Main Results:

• Systemic t-PA was administered to 250 patients (4%).
• Symptomatic and asymptomatic parenchymal hemorrhage occurred in 8.8% of treated patients, with 3 fatal cases.
• After 3 months, 35% of patients had a favorable outcome (mRS ≤ 1), 23.8% were severely disabled (mRS ≥ 4), and 17% had died.

Conclusions:

• Thrombolytic therapy is safe and effective in daily clinical practice for acute ischemic stroke.
• The low proportion of patients receiving thrombolysis, even in specialized centers, indicates a need for improved acute stroke management.
• Real-world data supports the efficacy of t-PA but highlights opportunities for wider application.