A case-control study of tissue plasminogen activator for acute ischemic stroke

Area of Science:

• Neurology
• Clinical Effectiveness Research
• Stroke Medicine

Background:

• Randomized trials confirm intravenous tissue plasminogen activator (tPA) efficacy in acute ischemic stroke (AIS).
• Assessing tPA's real-world effectiveness in routine clinical practice is crucial for patient outcomes.
• This study evaluated tPA treatment effectiveness in a single hospital setting.

Purpose of the Study:

• To compare the effectiveness of tPA treatment for AIS in routine clinical practice against a matched control group.
• To assess the translation of tPA's proven efficacy into real-world patient outcomes.
• To identify factors influencing tPA effectiveness in a non-trial setting.

Main Methods:

• A case-control study design was employed, matching 151 tPA-treated AIS patients with controls.
• Matching criteria included age, gender, pre-stroke functional status (Oxford Handicap Scale - OHS), stroke severity, and subtype.
• Key outcomes assessed were in-hospital death, symptomatic intracranial hemorrhage (SICH), length-of-stay (LOS), discharge OHS, and long-term survival.

Main Results:

• No significant difference in in-hospital mortality or long-term survival between tPA-treated patients and controls.
• Symptomatic intracranial hemorrhage (SICH) occurred in 7.8% of tPA-treated patients.
• A higher proportion of tPA-treated patients achieved no disability at discharge (OHS ≤ 1), but overall discharge independence and home discharge rates were similar.

Conclusions:

• Intravenous tPA demonstrated minor improvements in early stroke recovery in routine practice.
• The observed effectiveness was less pronounced than reported in randomized controlled trials.
• Potential reasons for the diminished impact include variations in treatment timing and patient selection criteria.