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

Michal Karlinski, Adam Kobayashi, Anna Czlonkowska, Robert Mikulik, Daniel Vaclavik, Miroslav Brozman, Zuzana Gdovinova, Viktor Švigelj, L. Csiba, Klara Fekete, Janika Kõrv, Vida Demarin, Vanja Bašic-Kes, Aleksandras Vilionskis, Dalius Jatuzis, Yakup Krespi, Nikolay Shamalov, Silva Andonova, Niaz Ahmed, Nils Wahlgren

Research output: Contribution to journalArticle

7 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)3184-3189
Number of pages6
JournalStroke
Volume46
Issue number11
DOIs
Publication statusPublished - Nov 1 2015

Fingerprint

Stroke
Tissue Plasminogen Activator
Odds Ratio
Confidence Intervals
Eastern Europe
Cerebral Hemorrhage
Licensure
Hyperlipidemias
Patient Selection
Registries
Logistic Models
Hypertension
Safety
Therapeutics

Keywords

  • acute stroke
  • alteplase
  • off-label use
  • recurrence
  • thrombolysis
  • treatment outcome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Clinical Neurology
  • Advanced and Specialised Nursing

Cite this

Karlinski, M., Kobayashi, A., Czlonkowska, A., Mikulik, R., Vaclavik, D., Brozman, M., ... Wahlgren, N. (2015). Intravenous Thrombolysis for Stroke Recurring Within 3 Months from the Previous Event. Stroke, 46(11), 3184-3189. https://doi.org/10.1161/STROKEAHA.115.010420

Intravenous Thrombolysis for Stroke Recurring Within 3 Months from the Previous Event. / Karlinski, Michal; Kobayashi, Adam; Czlonkowska, Anna; Mikulik, Robert; Vaclavik, Daniel; Brozman, Miroslav; Gdovinova, Zuzana; Švigelj, Viktor; Csiba, L.; Fekete, Klara; Kõrv, Janika; Demarin, Vida; Bašic-Kes, Vanja; Vilionskis, Aleksandras; Jatuzis, Dalius; Krespi, Yakup; Shamalov, Nikolay; Andonova, Silva; Ahmed, Niaz; Wahlgren, Nils.

In: Stroke, Vol. 46, No. 11, 01.11.2015, p. 3184-3189.

Research output: Contribution to journalArticle

Karlinski, M, Kobayashi, A, Czlonkowska, A, Mikulik, R, Vaclavik, D, Brozman, M, Gdovinova, Z, Švigelj, V, Csiba, L, Fekete, K, Kõrv, J, Demarin, V, Bašic-Kes, V, Vilionskis, A, Jatuzis, D, Krespi, Y, Shamalov, N, Andonova, S, Ahmed, N & Wahlgren, N 2015, 'Intravenous Thrombolysis for Stroke Recurring Within 3 Months from the Previous Event', Stroke, vol. 46, no. 11, pp. 3184-3189. https://doi.org/10.1161/STROKEAHA.115.010420
Karlinski M, Kobayashi A, Czlonkowska A, Mikulik R, Vaclavik D, Brozman M et al. Intravenous Thrombolysis for Stroke Recurring Within 3 Months from the Previous Event. Stroke. 2015 Nov 1;46(11):3184-3189. https://doi.org/10.1161/STROKEAHA.115.010420
Karlinski, Michal ; Kobayashi, Adam ; Czlonkowska, Anna ; Mikulik, Robert ; Vaclavik, Daniel ; Brozman, Miroslav ; Gdovinova, Zuzana ; Švigelj, Viktor ; Csiba, L. ; Fekete, Klara ; Kõrv, Janika ; Demarin, Vida ; Bašic-Kes, Vanja ; Vilionskis, Aleksandras ; Jatuzis, Dalius ; Krespi, Yakup ; Shamalov, Nikolay ; Andonova, Silva ; Ahmed, Niaz ; Wahlgren, Nils. / Intravenous Thrombolysis for Stroke Recurring Within 3 Months from the Previous Event. In: Stroke. 2015 ; Vol. 46, No. 11. pp. 3184-3189.
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