Marie Louise Schmitz1, Claus Z Simonsen2, Heidi Hundborg2, Hanne Christensen2, Karsten Ellemann2, Karin Geisler2, Helle Iversen2, Charlotte Madsen2, Mary-Jette Rasmussen2, Karsten Vestergaard2, Grethe Andersen2, Soeren P Johnsen2. 1. From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.). mariesch@rm.dk. 2. From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
Abstract
BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49-0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68-1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24-1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients. CONCLUSIONS: Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.
BACKGROUND AND PURPOSE: Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke. METHODS: We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes. RESULTS: Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49-0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68-1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24-1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients. CONCLUSIONS: Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.
Authors: Himanshu Shekhar; Kenneth B Bader; Shenwen Huang; Tao Peng; Shaoling Huang; David D McPherson; Christy K Holland Journal: Phys Med Biol Date: 2016-12-21 Impact factor: 3.609
Authors: Sidsel Hastrup; Soren P Johnsen; Thorkild Terkelsen; Heidi H Hundborg; Paul von Weitzel-Mudersbach; Claus Z Simonsen; Niels Hjort; Anette T Møller; Thomas Harbo; Marika S Poulsen; Noella Ruiz de Morales Ayudarte; Dorte Damgaard; Grethe Andersen Journal: Neurology Date: 2018-06-15 Impact factor: 9.910