Trends of r-tPA (Recombinant Tissue-Type Plasminogen Activator) Treatment and Treatment-Influencing Factors in Acute Ischemic Stroke

Abstract

Background and Purpose— Frequencies of treatment with r-tPA (recombinant tissue-type plasminogen activator) are increasing over the past 15 years. However, published data on the influence of various demographic and clinical factors on r-tPA treatment as well as estimates of future trajectories are limited. We evaluated time trends and future trajectories of r-tPA treatment in patients with acute stroke and the influence of various factors on r-tPA treatment by analyzing data of 103 970 patients enrolled in the Austrian Stroke Unit Registry from 2006 to 2018, of which 18 953 were treated with r-tPA. Methods— Time trends of r-tPA-treatment were investigated in predefined subgroups (minor/major stroke, age, anterior/posterior circulation stroke); limited exponential time series models were calculated to estimate future trends of r-tPA-treatment. Logistic regression models were calculated to estimate the influence of clinical variables on r-tPA-treatment. Results— Overall, r-tPA treatment frequencies increased from 9.9% in 2006 to 21.8% in 2018. We observed a particular increase in patients >80 years, patients presenting with a National Institutes of Health Stroke Scale Score of 2 to 3, patients with posterior circulation stroke, patients with wake-up stroke, and patients without atrial fibrillation. Forecast of overall r-tPA frequencies predicted a further but flattened increase up to 24% by 2025. Logistic regression of time-dependent associations of clinical variables with r-tPA-treatment revealed increasing odds of r-tPA-treatment in patients with a posterior circulation stroke and decreasing odds of r-tPA-treatment in patients with atrial fibrillation. Conclusions— We observed a positive development of r-tPA-treatment frequencies mirroring increasing confidence with intravenous thrombolysis in clinical practice; however, decreasing odds of r-tPA-treatment over time in patients with atrial fibrillation deserve particular attention.

Eosinophil-to-Neutrophil Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

“…Stroke is one of the leading causes of mortality and morbidity worldwide ( 1 ). Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) was recommended for acute ischemic stroke (AIS) patients within 4.5 h of stroke onset, and an increasing trend of r-tPA treatment was discovered over the past 13 years ( 2 ). However, there were still nearly half of patients who went into major disability or died after 3 months of stroke onset.…”

Levels of Fibrin Degradation Products at Admission With Acute Ischemic Stroke Correlate With the NIH Stroke Scale Score 1 h After Intravenous Thrombolysis

“…Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) is an effective treatment for patients with AIS (4,5). Timely intravenous r-tPA (alteplase) administered in the early period (≤4.5 h) is recognized as a mainstay of the AIS treatment strategy (4,6,7). However, r-tPA has several shortcomings, such as a low recanalization rate, a risk of intracranial hemorrhage, and a short half-life requiring continuous infusion.…”

Acute Ischemic Stroke With Mild Symptoms–To Thrombolyse or Not to Thrombolyse?

“…In Austria, rates of rtPA treatment in patients with very mild symptoms (NIHSS 0-1) raised from 0.8% in 2006 to 3.5% in 2018 and for patients with a NIHSS 2–3 from 2.2% in 2006 to 17.2% in 2018 ( 34 ). Another large registry from 66 hospitals in Puerto Rico and Florida reported a substantial increase in thrombolysis rates of patients with minor stroke presenting within 4 h of stroke onset from 10% in 2010 to 25% in 2015 ( 14 ).…”