Thrombolytic therapy for patients who wake-up with stroke.
Thrombolytic therapy for patients who wake-up with stroke.
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DOI：
10.1161/strokeaha.108.528034
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发表时间：
2009-03
期刊：
影响因子：
8.3
通讯作者：
Savitz SI
中科院分区：
文献类型：
--
作者：
Barreto AD;Martin-Schild S;Hallevi H;Morales MM;Abraham AT;Gonzales NR;Illoh K;Grotta JC;Savitz SI
大约25%的缺血性中风患者醒来时有他们的缺陷。最后一次看到的正常时间被定义为患者进入睡眠状态的时间，该时间将这些患者置于窗口外进行溶栓治疗。这项研究的目的是描述我们中心对觉醒中风(WUS)患者进行标签外的同情性溶栓治疗的经验。对我们数据库的回顾发现了3组缺血性中风患者：(1)接受溶栓治疗的WUS患者；(2)未接受治疗的WUS患者；(3)接受0-3小时静脉注射组织型纤溶酶原激活剂的患者。安全性和临床结果指标为症状性脑出血、优良结果(出院后改良Rankin评分0~1)、良好结果(改良Rankin评分0~2)和死亡率。使用Logistic回归对基线NIHSS的结果进行控制。46例溶栓治疗的WUS患者和34例未溶栓的WUS患者被鉴定。在接受治疗的WUS患者中，61%(28/46)的患者仅接受静脉溶栓，而30%(14/46)的患者仅接受动脉内溶栓。4例同时接受静脉和动脉内溶栓治疗(9%)。治疗组有2例出现症状性脑出血(4.3%)。控制NIHSS失衡，治疗组的优良率(28%比13%；P=0.006)和病死率(15%比0%)明显高于未治疗组(P=0.06)。在控制基线NIHSS的第二次比较中，接受WUS治疗的患者和在症状出现3小时内接受治疗的174名静脉注射组织型纤溶酶原激活剂患者在安全性和临床结果方面没有显著差异。WUS患者溶栓治疗可能是安全的。我们中心的经验支持考虑一项前瞻性随机试验，以评估这一特定患者群体溶栓治疗的安全性和结果。
Approximately 25% of ischemic stroke patients awaken with their deficits. The last-seen-normal time is defined as the time the patient went to sleep, which places these patients outside the window for thrombolysis. The purpose of this study was to describe our center’s experience with off-label, compassionate thrombolysis for wake-up stroke (WUS) patients. A retrospective review of our database identified 3 groups of ischemic stroke patients: (1) WUS treated with thrombolysis; (2) nontreated WUS; and (3) 0- to 3-hour intravenous tissue plasminogen activator-treated patients. Safety and clinical outcome measures were symptomatic intracerebral hemorrhage, excellent outcome (discharge modified Rankin score, 0–1), favorable outcome (modified Rankin score, 0–2), and mortality. Outcome measures were controlled for baseline NIHSS using logistic regression. Forty-six thrombolysed and 34 nonthrombolysed WUS patients were identified. Sixty-one percent (28/46) of the treated WUS patients underwent intravenous thrombolysis alone whereas 30% (14/46) were given only intra-arterial thrombolysis. Four patients received both intravenous and intra-arterial thrombolysis (9%). Two symptomatic intracerebral hemorrhages occurred in treated WUS (4.3%). Controlling for NIHSS imbalance, treated WUS had higher rates of excellent (14% vs 6%; P=0.06) and favorable outcome (28% vs 13%; P=0.006), but higher mortality (15% vs 0%) compared to nontreated WUS. A second comparison controlling for baseline NIHSS between treated WUS and 174 intravenous tissue plasminogen activator patients treated within 3 hours of symptoms showed no significant differences in safety and clinical outcomes. Thrombolysis may be safe in WUS patients. Our center’s experience supports considering a prospective, randomized trial to assess the safety and outcome of thrombolysis for this specific patient population.