Τίτλος:
Intravenous thrombolysis for patients with in-hospital stroke onset: propensity-matched analysis from the Safe Implementation of Treatments in Stroke-East registry
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background and purpose: Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital stroke (IHS) onset is associated with unfavorable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke (OHS) onset treated with IVT. We sought to compare outcomes between IVT-treated patients with IHS and OHS by analysing propensity-score-matched data from the Safe Implementation of Treatments in Stroke-East registry. Methods: We compared the following outcomes for all propensity-score-matched patients: (i) symptomatic intracranial hemorrhage defined with the safe implementation of thrombolysis in stroke-monitoring study criteria, (ii) favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0–1 at 3 months, (iii) functional independence defined as an mRS score of 0–2 at 3 months and (iv) 3-month mortality. Results: Out of a total of 19 077 IVT-treated patients with acute ischaemic stroke, 196 patients with IHS were matched to 5124 patients with OHS, with no differences in all baseline characteristics (P > 0.1). Patients with IHS had longer door-to-needle [90 (interquartile range, IQR, 60–140) vs. 65 (IQR, 47–95) min, P < 0.001] and door-to-imaging [40 (IQR, 20–90) vs. 24 (IQR, 15–35) min, P < 0.001] times compared with patients with OHS. No differences were detected in the rates of symptomatic intracranial hemorrhage (1.6% vs. 1.9%, P = 0.756), favorable functional outcome (46.4% vs. 42.3%, P = 0.257), functional independence (60.7% vs. 60.0%, P = 0.447) and mortality (14.3% vs. 15.1%, P = 0.764). The distribution of 3-month mRS scores was similar in the two groups (P = 0.273). Conclusions: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS. © 2017 EAN
Συγγραφείς:
Tsivgoulis, G.
Katsanos, A.H.
Kadlecová, P.
Czlonkowska, A.
Kobayashi, A.
Brozman, M.
Švigelj, V.
Csiba, L.
Fekete, K.
Kõrv, J.
Demarin, V.
Vilionskis, A.
Jatuzis, D.
Krespi, Y.
Karapanayiotides, T.
Giannopoulos, S.
Mikulik, R.
Περιοδικό:
European Journal of Paediatric Neurology
Εκδότης:
Wiley-Blackwell Publishing Ltd
Λέξεις-κλειδιά:
tissue plasminogen activator; fibrinolytic agent; tissue plasminogen activator, aged; Article; blood clot lysis; brain hemorrhage; brain ischemia; disease registry; female; functional assessment; human; independence; major clinical study; male; mortality; outcome assessment; priority journal; propensity score; Rankin scale; time to treatment; brain ischemia; cerebrovascular accident; cross-sectional study; fibrinolytic therapy; hospital; intravenous drug administration; middle aged; procedures; register; treatment outcome; very elderly, Aged; Aged, 80 and over; Brain Ischemia; Cross-Sectional Studies; Female; Fibrinolytic Agents; Hospitals; Humans; Infusions, Intravenous; Male; Middle Aged; Propensity Score; Registries; Stroke; Thrombolytic Therapy; Time-to-Treatment; Tissue Plasminogen Activator; Treatment Outcome
