Intravenous Thrombolysis for Stroke Recurring Within 3 Months From the Previous Event

Abstract

Background and Purpose-According to the European license, alteplase can be given no sooner than 3 months after previous stroke. However, it is not known whether past history of stroke influences the effect of treatment. Our aim was to evaluate safety and functional outcome after intravenous thrombolysis administered in everyday practice to patients with previous stroke ≤3 months compared with those with first-ever stroke. Methods-We analyzed consecutive cases treated with alteplase between October 2003 and July 2014 contributed to the Safe Implementation of Thrombolysis for Stroke-Eastern Europe registry from 12 countries. Odds ratios were calculated using unadjusted and adjusted logistic regression. Results-Of 13 007 patients, 11 221 (86%) had no history of stroke and 249 (2%) experienced previous stroke ≤3 months before admission. Patients with previous stroke ≤3 months had a higher proportion of hypertension and hyperlipidemia. There were no significant differences in outcome, including symptomatic intracerebral hemorrhage according to European Cooperative Acute Stroke Study (unadjusted odds ratio 1.27, 95% confidence interval: 0.74-2.15), and being alive and independent at 3 months (odds ratio 0.81, 95% confidence interval: 0.61-1.09). Conclusions-Patients currently treated with alteplase, despite a history of previous stroke ≤3 months, do not seem to achieve worse outcome than those with first-ever stroke. Although careful patient selection was probably of major importance, our findings provide reassurance that this group of patients may safely benefit from thrombolysis and should not be arbitrarily excluded as a whole. Further studies are needed to identify the shortest safe time lapse from the previous event to treatment with alteplase.

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

“…Moreover, AIS patients, with a previous history of stroke, migraines, obesity, direct admission, and Caucasian ethnicity were more likely to exhibit neurologic improvement following thrombolytic therapy. These findings are consistent with a single-center study involving small cohorts which shows that a history of stroke [47,48], migraines [49], obesity [50,51] and direct admission into the neurological unit [52] were associated with improved functional outcomes following thrombolytic therapy. In addition, our finding that AIS patients without prior cholesterol reducer use who presented with increased age and higher heart rate had a likelihood of worsening neurological function following thrombolytic shows consistency with previous studies [9,53,54].…”

Why not Intravenous Thrombolysis in Patients with Recurrent Stroke within 3 Months?

“…At 3-month follow-up, 3 patients had an mRS of ≤2. Similar results were reported by Karlinski [ 33 ] and Kahles [ 34 ], they found that intravenous thrombolysis in patients with prior strokes in previous 3 months did not increase the risk of sICH.…”

“…This may also be the case in patients with history of stroke within 3 months. Karlinski et al [ 33 ] retrospectively analyzed the data in the Safe Implementation of Thrombolysis for Stroke database, which consisted of 13,007 cases of patients with thrombolysis from 12 countries in central and eastern Europe between October 2013 and July 2014. Overall, 11,221 (86%) patients had no history of stroke and 249 (2%) had a stroke in the past 3 months.…”

Safety Outcomes After Thrombolysis for Acute Ischemic Stroke in Patients With Recent Stroke

“…These findings are consistent with and build upon those reported in previous, smaller studies. 6, 7 The higher risk of death and unfavorable discharge disposition may be due to recurrent strokes generally being more severe and disabling, as well as more limitations of care in patients that have a second stroke. Furthermore, in an exploratory analysis in patients with claims for AIS not treated with IV-tPA, recent ischemic stroke remained associated with an increased risk of unfavorable discharge disposition and inpatient death, suggesting that recurrent ischemic stroke rather than treatment with IV-tPA portends poor outcome.…”