Temporal trends in acute stroke management.
Temporal trends in acute stroke management.
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DOI：
10.1161/strokeaha.113.001457
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发表时间：
2013-06
期刊：
影响因子：
8.3
通讯作者：
Adeoye O
中科院分区：
文献类型：
--
作者：
Kleindorfer D;de los Rios La Rosa F;Khatri P;Kissela B;Mackey J;Adeoye O
S130卒中2013年6月研究。如果不需要这些标准中的一些，则合格患者的百分比以及接受这种治疗的卒中患者的数量可能会增加。例如，治疗轻度卒中缺陷的患者可能至少使rt-PA的使用率增加一倍。10然而，需要进一步的研究来确定rt-PA在这一人群中的益处。最近重新考虑的排除标准是给予溶解治疗的时间窗非常有限。2008年，欧洲急性卒中合作研究（ECASS）-III研究成功地将溶栓治疗的急性治疗时间窗从症状发作后0 - 3小时扩展到0 - 4.5小时。2这促使美国心脏协会发表了一份咨询声明，建议在ECASS-III资格标准（年龄< 80岁;无论血清凝血试验如何，均不使用口服抗凝剂，无糖尿病和既往卒中病史，美国国立卫生研究院卒中量表必须< 25）的设定下，在3至4.5小时的扩展时间窗内进行治疗。[11]然而，在人群中扩大的时间窗导致了令人失望的发现，即这种扩大增加了很少的额外合格的中风患者。在大辛辛那提/北方肯塔基州人群中，扩大的治疗时间窗结合沿着额外的ECASSIII排除标准，仅会导致2005年有资格接受rt-PA治疗的缺血性卒中患者增加0.6%。[12]这与缺血性卒中患者就医时间的双峰分布有关。只有9%的中风患者在3至8小时的时间窗内到达。8中风患者往往来得很早或很晚。这一发现在其他人群中也得到了证实。9此外，联邦药品管理局拒绝批准延长rt-PA获批用途的时间窗，这可能会进一步降低延长时间窗的影响。总之，美国缺血性卒中患者中rt-PA的使用率仍然较低。这很可能与溶栓治疗的合格性有关，尤其是
S130 Stroke June 2013 study. If some of these criteria were not required, it is possible that the percentage of eligible patients, and thereby the number of stroke patients receiving this therapy, would increase. For example, treating patients with mild stroke deficits could potentially at least double the rate of rt-PA use. 10 However, further study is needed to determine the benefit of rt-PA within this population.An exclusion criterion recently reconsidered was the extremely limited time window for giving lytic therapy. In 2008, the European Cooperative Acute Stroke Study (ECASS)-III study successfully expanded the time window for acute treatment with thrombolytic therapy from 0 to 3 hours to 0 to 4.5 hours from symptom onset. 2 This prompted the American Heart Association to publish an advisory statement recommending treatment in the expanded time window of 3 to 4.5 hours, in the setting of ECASS-III eligibility criteria (age,< 80 years; no oral anticoagulants regardless of serum coagulation testing, no patients with a history of both diabetes mellitus and a prior stroke, and National Institutes of Health Stroke Scale must be< 25). 11 This expanded time window within a population, however, leads to the disappointing finding that this expansion adds very few additional eligible stroke patients. In the Greater Cincinnati/Northern Kentucky population, the combination of the expanded time window for treatment, along with the additional ECASSIII exclusion criteria, would have only led to an additional 0.6% more ischemic stroke patients becoming eligible for rt-PA in 2005. 12 This is related to the bimodal distribution of times that ischemic stroke patients present to medical attention. Only 9% of all stroke patients arrive in the 3-to 8-hour time window. 8 Stroke patients tend to arrive very early or quite late. This finding has also been confirmed in other populations. 9 Furthermore, the Federal Drug Administration denied approval of the expansion of the time window for the approved uses of rt-PA, which may further minimize the impact of the expanded time window. In summary, the rate of rt-PA use in ischemic stroke patients remains low in the United States. This is most likely related to eligibility for thrombolytic therapy, especially the very