Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study
Use of alteplase in childhood arterial ischaemic stroke: a multicentre, observational, cohort study
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DOI：
10.1016/s1474-4422(09)70106-1
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发表时间：
2009-06-01
期刊：
影响因子：
48
通讯作者：
Ichord, Rebecca
中科院分区：
文献类型：
--
作者：
Amlie-Lefond, Catherine;deVeber, Gabrielle;Ichord, Rebecca
背景：儿童急性卒中后溶栓的安全性和有效性尚未确定。我们的目的是描述目前的做法和结果的使用阿替普酶急性动脉缺血性中风的儿童登记在国际儿科中风登记，并比较目前的做法与那些发表的病例报告和指南使用阿替普酶的成人stroke.Methods在这个多中心的观察性队列研究，我们分析了临床特点，剂量和治疗时间，以及2003年1月至2007年7月期间入组国际儿科卒中研究（IPSS）的接受阿替普酶治疗急性动脉缺血性卒中的儿童的短期结局。从IPSS的调查结果进行了比较与发表的病例报告的临床特征，遵守成人指南阿替普酶，outcome.Findings的687例儿童急性动脉缺血性卒中入组的IPSS，15（2%）接受阿替普酶：9接受静脉阿替普酶和6接受动脉内阿替普酶。从卒中发作至治疗的中位时间为3.3 h（范围2.0-52.0 h）（静脉阿替普酶）和4.5 h（3.8-24.0 h）（动脉阿替普酶）。2名患者死亡（1名死于大面积梗死和脑疝，1名死于脑干梗死）。出院时，1例患者健康，12例患者有神经功能缺损。15例患者中有4例发生阿替普酶给药后颅内出血，但出血事件均未被判定为急性症状。当与10名患者在发表的文章中报道谁是静脉注射阿替普酶相比，在IPSS队列中的9名患者大多是年轻的，等待更长的治疗时间，并有更差的结果，这表明有一个出版偏见短的治疗间隔从症状发作和有利outcomes.Interpretation儿童急性中风接受阿替普酶不频繁，并在时间间隔，往往偏离成人指南。尽管未报告阿替普酶相关死亡或症状性颅内出血，但神经系统结局不良很常见。需要临床试验来评估阿替普酶治疗儿童卒中的剂量、安全性和有效性。
Background The safety and efficacy of thrombolysis after acute stroke in children have not been established. Our aim was to describe current practices and results of the use of alteplase for acute arterial ischaemic stroke in children enrolled in an international pediatric stroke registry and to compare current practices with those published in case reports and with guidelines for the use of alteplase for adult stroke.Methods In this multicentre observational cohort study, we analysed the clinical features, the dosing and timing of treatment, and the short-term outcome in children treated with alteplase for acute arterial ischaemic stroke who were enrolled in the International Pediatric Stroke Study (IPSS) between January, 2003, and July, 2007. The findings from the IPSS were compared with published case reports for clinical features, adherence to adult guidelines for alteplase, and outcomes.Findings Of 687 children with acute arterial ischaemic stroke enrolled in the IPSS, 15 (2%) received alteplase: nine received intravenous alteplase and six received intra-arterial alteplase. The median time to treatment from stroke onset was 3.3 h (range 2.0-52.0 h) for intravenous alteplase and 4.5 h (3.8-24.0 h) for intra-arterial alteplase. Two patients died (one owing to massive infarction and brain herniation, and one owing to brainstem infarction). At discharge from hospital, one patient was healthy and 12 patients had neurological deficits. Intracranial haemorrhage after alteplase occurred in four of 15 patients, although none of the bleeding events was judged to be acutely symptomatic. When compared with ten patients reported in published articles who were given intravenous alteplase, the nine patients in the IPSS cohort were mostly younger, waited longer for treatment, and had worse outcomes, which suggests there is a publication bias towards short treatment intervals from symptom onset and favourable outcomes.Interpretation Children with acute stroke received alteplase infrequently and at time intervals that often deviated from adult guidelines. Although no alteplase-related deaths or symptomatic intracranial haemorrhage was reported, poor neurological outcome was common. Clinical trials to evaluate the dose and the safety and efficacy of alteplase are needed in childhood stroke.