Discontinuation of intravenous thrombolysis in acute ischemic stroke

Alteplase (rt-PA) was the standard thrombolytic in acute ischemic stroke (AIS) for decades. Due to its short half-life it must be administered over 1 h after an initial bolus, but the administration can be stopped when serious side effects occur. However, there are limited data about the frequency and reasons for interrupted or stopped intravenous thrombolysis (IVT) in AIS.

We retrospectively analyzed our stroke registry over a time of more than six years (January 1, 2018 - March 31, 2024) to determine the proportion of discontinued IVT. We compared the baseline, stroke and treatment characteristics between discontinued and non-discontinued patients. We investigated the reasons for discontinuation and followed up patients who had discontinued treatment to detect any treatment-related complications.

Total 1,504 patients underwent IVT with rt-PA and the treatment was discontinued in 23 patients (1.5%). Of these, 5 patients (0.3%) had their treatment interrupted and 18 patients (1.2%) had their treatment stopped early. On average 61% of the planned dosage was administered in the discontinued patients. The most common reasons for discontinuation were extracranial bleedings, reevaluation of the acute cerebral imaging and deterioration of the neurological symptoms incl. patient agitation. In 7 patients the discontinuation was due to adverse effects of rt-PA, but no patient suffered a symptomatic intracranial hemorrhage. The proportion of additional endovascular thrombectomy was higher in patients with discontinuation than in patients without (47.8% vs. 27.9%; p = 0.035).

In our cohort, discontinuation of IVT in the treatment of acute ischemic stroke was rare and the quantity of not administered rt-PA was low.

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