BACKGROUND: Although tissue plasminogen activator (tPA) has been approved for use in acute ischemic stroke, concerns linger regarding its safety. We analyzed whether patients in special subgroups (i.e., age >70 years, baseline National Institute of Health Stroke Scale (NIHSS) score >20, diabetes, congestive heart failure (CHF), and of Hispanic origin) have a higher risk of symptomatic intracerebral hemorrhage (SICH) than patients without these characteristics. METHODS: Four prospective observational studies of acute ischemic stroke patients treated within 3 h with Alteplase were identified and individual patient data were pooled for this analysis. These included the Standard Treatment with Alteplase to Reverse Stroke Study [STARS, N = 389], Epidemiology Study of Ischemic Stroke [ESIS, N = 236], University Of Texas Houston Stroke Study [UT, N = 241], and Canadian Activase For Stroke Effectiveness Study [CASES, N = 1100]. The risk of SICH was calculated for all patients and for each of five subgroups. RESULTS: A total of 1966 patients were studied. Overall the risk of symptomatic ICH was 4.7% (95%CI, 3.8-5.8%) and the risk was similar among patients with and without each of the five characteristics. Patients with advanced age, baseline NIHSS score >20, CHF or diabetes had increased mortality and significantly lower rate of functional recovery. CONCLUSIONS: The present study suggests that these specified subgroups of patients are not at increased risk of SICH after stroke thrombolysis compared to those without these characteristics.
BACKGROUND: Although tissue plasminogen activator (tPA) has been approved for use in acute ischemic stroke, concerns linger regarding its safety. We analyzed whether patients in special subgroups (i.e., age >70 years, baseline National Institute of Health Stroke Scale (NIHSS) score >20, diabetes, congestive heart failure (CHF), and of Hispanic origin) have a higher risk of symptomatic intracerebral hemorrhage (SICH) than patients without these characteristics. METHODS: Four prospective observational studies of acute ischemic strokepatients treated within 3 h with Alteplase were identified and individual patient data were pooled for this analysis. These included the Standard Treatment with Alteplase to Reverse Stroke Study [STARS, N = 389], Epidemiology Study of Ischemic Stroke [ESIS, N = 236], University Of Texas Houston Stroke Study [UT, N = 241], and Canadian Activase For Stroke Effectiveness Study [CASES, N = 1100]. The risk of SICH was calculated for all patients and for each of five subgroups. RESULTS: A total of 1966 patients were studied. Overall the risk of symptomatic ICH was 4.7% (95%CI, 3.8-5.8%) and the risk was similar among patients with and without each of the five characteristics. Patients with advanced age, baseline NIHSS score >20, CHF or diabetes had increased mortality and significantly lower rate of functional recovery. CONCLUSIONS: The present study suggests that these specified subgroups of patients are not at increased risk of SICH after stroke thrombolysis compared to those without these characteristics.
Authors: I L Katzan; A J Furlan; L E Lloyd; J I Frank; D L Harper; J A Hinchey; J P Hammel; A Qu; C A Sila Journal: JAMA Date: 2000-03-01 Impact factor: 56.272
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Authors: A M Demchuk; L B Morgenstern; D W Krieger; T Linda Chi; W Hu; T H Wein; R J Hardy; J C Grotta; A M Buchan Journal: Stroke Date: 1999-01 Impact factor: 7.914
Authors: J H Gurwitz; J M Gore; R J Goldberg; H V Barron; T Breen; A C Rundle; M A Sloan; W French; W J Rogers Journal: Ann Intern Med Date: 1998-10-15 Impact factor: 25.391
Authors: Joshua Z Willey; Santiago Ortega-Gutierrez; Nils Petersen; Pooja Khatri; Andria L Ford; Natalia S Rost; Latisha K Ali; Nichole R Gonzales; Jose G Merino; Brett C Meyer; Randolph S Marshall Journal: Stroke Date: 2012-07-12 Impact factor: 7.914