Thrombolysis management in thrombectomy patients: Real-life data from German stroke centres

In randomised clinical trials (RCTs), endovascular thrombectomy (ET) was combined with intravenous thrombolysis (IVT) in the vast majority of patients. We aimed to analyse how German stroke centres manage IVT in patients receiving ET in daily routine.

We performed an online survey among neurologists and neurointerventionalists that included all German University hospitals and a selection of German community hospitals known to perform ET. The survey consisted of 20 questions and was open for reply from 20 December 2016 to 9 January 2017.

Overall, there were 110 replies, 76% (84/110) from neurologists and 20% (22/110) from neurointerventionalists. The majority of participants (75/99, 76%) reported to continue IVT after start of ET. Nine participants (9%) reported to stop IVT as a standard of care before ET and another 15 (15%) reported to stop IVT on a case-by-case basis. Thrombolysis is given intra-arterially in individual cases in 39% (37/99) and as a standard of care in 3% (3/99). Intra-arterial Heparin is given additionally as a standard procedure in 25% (24/96) and in individual cases in 11% (11/96). IVT is omitted even without contraindications before ET in 5% (5/95) as standard procedure and in 14% (13/95) in individual cases.

We observed a wide heterogeneity with respect to the management of IVT in the context of ET. Evidence from RCTs is not implemented in a large number of cases.

These findings emphasise a requirement for further education and implementation of standards for the management of intravenous thrombolysis in endovascular treated stroke patients.