Repeated Intravenous Thrombolysis for Early Recurrent Stroke: Challenging the Exclusion Criterion.

Kahles, Timo; Mono, Marie-Luise; Heldner, Mirjam Rachel; Baumgartner, Ralf; Sarikaya, Hakan; Luft, Andreas; Bohlhalter, Stephan; Traenka, Christopher; Engelter, Stefan T; Kurka, Natalia; Köhrmann, Martin; Curtze, Sami; Michel, Patrik; Tatlisumak, Turgut; Nedeltchev, Krassen (2016). Repeated Intravenous Thrombolysis for Early Recurrent Stroke: Challenging the Exclusion Criterion. Stroke, 47(8), pp. 2133-2135. Lippincott Williams & Wilkins 10.1161/STROKEAHA.116.013599

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BACKGROUND AND PURPOSE Intravenous thrombolysis (IVT) within 4.5 hours from symptom onset improves functional outcome in patients with acute ischemic stroke. Its use in patients with previous stroke within the preceding 3 months is contraindicated because of the assumed higher risk of intracranial hemorrhage. In addition, tissue-type plasminogen activator may itself promote neurotoxicity and blood-brain barrier disruption. However, safety and effectiveness of repeated IVT is essentially unknown in patients with early (<3 months) recurrent stroke (ERS), because they were excluded from thrombolysis trials. This article reports the largest case series of repeated IVT in ERS. METHODS We reviewed databases of prospectively collected patient data of 8 European stroke centers for the presence of patients with ERS, who received IVT for both the index stroke and ERS. Demographics, clinical and radiological data, bleeding complications, and functional outcome were analyzed. RESULTS We identified 19 subjects with repeated IVT in ERS. Mean age was 68±12 years, and 37% of them were female. Median interthrombolysis interval was 30 days (interquartile range, 13-50). Functional independence (modified Rankin scale score ≤2) was achieved in 79% of patients after the first and in 47.4% after repeated IV tissue-type plasminogen activator, respectively. There was no symptomatic intracranial hemorrhage. Median final infarct volume after the first IVT was 1.5 cm(3) (interquartile range, 0.5-3.1). CONCLUSIONS Patients with small infarct volumes and robust clinical improvement might be considered for repeated IVT within 3 months. Studies following strict protocols and larger registries incorporating these patients might serve to identify selection criteria for the safe use of repeated IVT in ERS.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Kahles, Timo; Mono, Marie-Luise; Heldner, Mirjam Rachel; Baumgartner, Ralf; Sarikaya, Hakan and Nedeltchev, Krassen

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Stefanie Hetzenecker

Date Deposited:

19 Sep 2016 08:28

Last Modified:

19 Sep 2016 08:28

Publisher DOI:

10.1161/STROKEAHA.116.013599

PubMed ID:

27364530

Uncontrolled Keywords:

hemorrhage; hospitalization; myocardial infarction; pulmonary embolism; stroke

BORIS DOI:

10.7892/boris.87808

URI:

https://boris.unibe.ch/id/eprint/87808

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