Characteristics of blood tests in patients with acute cerebral infarction who developed symptomatic intracranial hemorrhage after intravenous administration of recombinant tissue plasminogen activator

To assess the efficacy of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis on clinical outcomes and risk of death in patients with acute cerebral infarction. Patients (n = 258) with acute cerebral infarction, treated within 4–5 h of the episode, were grouped according to whether intravenous thrombolysis was performed using rt-PA or not. Both groups received routine treatment for cerebral infarction, but the former received rt-PA intravenously at a dosage of 0.9 mg/kg. The National Institutes of Health Stroke Scale (NIHSS) score, clinical efficacy, and risk of bleeding and death were compared between the two groups. The NIHSS score and clinical effects for the rt-PA group were more favorable than those of its counterpart (P < 0.05), though there was no significant difference in risk of an intracranial hemorrhage. The mortality rate for the rt-PA group was lower than that of the control group (P < 0.05). Administration of intravenous rt-PA thrombolysis within 4.5 h of an acute cerebral infarction had a significant impact and did not increase risk of intracranial hemorrhage or death.

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Clinical Study of Intravenous, Low-Dose Recombinant Tissue Plasminogen Activator for Acute Cerebral Infarction: Comparison of Treatment within 3 Hours versus 3-4.5 Hours

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2017.11.009 ◽

2018 ◽

Vol 27 (4) ◽

pp. 1033-1040 ◽

Cited By ~ 4

Author(s):

Ichiro Deguchi ◽

Norio Tanahashi ◽

Masaki Takao

Keyword(s):

Clinical Study ◽

Cerebral Infarction ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Low Dose ◽

Recombinant Tissue Plasminogen Activator ◽

Acute Cerebral Infarction ◽

Tissue Plasminogen

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Intraarterial Thrombolytic Therapy within 3 Hours of the Onset of Stroke

Neurosurgery ◽

10.1227/01.neu.0000097197.61376.05 ◽

2004 ◽

Vol 54 (1) ◽

pp. 39-46 ◽

Cited By ~ 19

Author(s):

Eric C. Bourekas ◽

Andrew P. Slivka ◽

Rajul Shah ◽

Robert W. Tarr ◽

Jeffrey Sunshine ◽

...

Keyword(s):

Mortality Rate ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Scale Score ◽

Intracranial Hemorrhage ◽

Recombinant Tissue Plasminogen Activator ◽

Stroke Onset ◽

Modified Rankin Scale ◽

Tissue Plasminogen ◽

Symptomatic Intracranial Hemorrhage

Abstract OBJECTIVE The National Institute of Neurological Disorders and Stroke (NINDS) Recombinant Tissue Plasminogen Activator Stroke Study Group showed that recombinant tissue plasminogen activator (rt-PA) administered intravenously within 3 hours of the onset of ischemic stroke can improve clinical outcome. Intraarterial (IA) thrombolysis has been shown to offer advantages over intravenous (IV) thrombolysis, but experience with this type of therapy within 3 hours of the onset of symptoms has not been reported previously. This study is the first retrospective analysis of a two-institution experience with IA thrombolysis within 3 hours of stroke onset. METHODS A total of 36 patients with angiographically demonstrated occlusions were treated with urokinase or rt-PA within 3 hours of stroke onset. Outcome measures included the percentage of patients with no or minimal neurological disability at 30 to 90 days as measured by the modified Rankin Scale, percentage recanalization, incidence of symptomatic intracranial hemorrhage, and mortality rate. The results were compared with those of the NINDS rt-PA study. RESULTS The median admission National Institutes of Health Stroke Scale score was 14. Fifty percent of treated patients had a modified Rankin Scale score of 0 or 1 indicating no or little disability at 1 to 3 months compared with 39% of treated patients in the NINDS trial. Recanalization was 75%, symptomatic intracranial hemorrhage was 11% (versus 6.4% with IV rt-PA in the NINDS trial), and the mortality rate was 22% (versus 17% with IV rt-PA in the NINDS trial). CONCLUSION The results suggest that IA thrombolysis administered within 3 hours of stroke onset is a feasible and viable alternative to IV rt-PA on the basis of improved clinical outcomes, high recanalization percentage, and comparable mortality rate and despite increased symptomatic intracranial hemorrhage. Whether IA thrombolysis is superior to IV therapy awaits further study.

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