دورية أكاديمية
Thrombolysis at 3-4.5 hours after acute ischemic stroke onset--evidence from the Canadian Alteplase for Stroke Effectiveness Study (CASES) registry.
| العنوان: | Thrombolysis at 3-4.5 hours after acute ischemic stroke onset--evidence from the Canadian Alteplase for Stroke Effectiveness Study (CASES) registry. |
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| المؤلفون: | Shobha N; Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada., Buchan AM, Hill MD |
| مؤلفون مشاركون: | Canadian Alteplase for Stroke Effectiveness Study (CASES) |
| المصدر: | Cerebrovascular diseases (Basel, Switzerland) [Cerebrovasc Dis] 2011; Vol. 31 (3), pp. 223-8. Date of Electronic Publication: 2010 Dec 21. |
| نوع المنشور: | Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Karger Country of Publication: Switzerland NLM ID: 9100851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1421-9786 (Electronic) Linking ISSN: 10159770 NLM ISO Abbreviation: Cerebrovasc Dis Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Basel ; New York : Karger, 1990- |
| مواضيع طبية MeSH: | Thrombolytic Therapy*/adverse effects , Thrombolytic Therapy*/mortality, Brain Ischemia/*drug therapy , Fibrinolytic Agents/*administration & dosage , Stroke/*drug therapy , Tissue Plasminogen Activator/*administration & dosage, Aged ; Aged, 80 and over ; Brain Ischemia/blood ; Brain Ischemia/complications ; Brain Ischemia/mortality ; Canada ; Chi-Square Distribution ; Drug Administration Schedule ; Female ; Fibrinolytic Agents/adverse effects ; Humans ; Infusions, Intravenous ; Intracranial Hemorrhages/chemically induced ; Male ; Middle Aged ; Patient Selection ; Prospective Studies ; Registries ; Regression Analysis ; Risk Assessment ; Risk Factors ; Stroke/blood ; Stroke/etiology ; Stroke/mortality ; Time Factors ; Tissue Plasminogen Activator/adverse effects ; Treatment Outcome |
| مستخلص: | Background: Extending the therapeutic window for thrombolysis is an important strategy in maximizing the proportion of patients treated. ECASS III examined a 3-4.5-hour window and showed a benefit to treated patients. We examined the experience in Canadian centres using intravenous tPA treatment in the 3-4.5-hour time window. Methods: The data were obtained from the CASES (Canadian Alteplase for Stroke Effectiveness Study)--a prospective, multicentric cohort study with patient enrollment from 60 centres across Canada over 2.5 years. The 90-day outcome, mortality and symptomatic intracranial hemorrhage of patients thrombolysed between 3 and 4.5 h and within 3 h of symptom onset were compared. A mRS 0-1 (no symptoms at all or no significant disability despite symptoms, able to carry out all usual duties and activities) at 90 days was defined as a favorable outcome. Results: A total of 1,112 patients with complete data were included. 129 (11.6%) patients received tPA between 3 and 4.5 h of symptom onset and 983 (88.4%) patients received tPA within 3 h. At 90 days, 39.4% of the patients in the 3-4.5-hour treatment group and 36.5% of patients in the under 3-hour treatment group attained a mRS ≤1. There were no differences between the two groups regarding their functional status at 3 months. There was a trend towards higher rate of sICH in the 3-4.5-hour group compared to the 0-3-hour group (7.8 vs. 3.8%, p = 0.06). Similarly there was a trend towards higher rate of deaths in the 3-4.5-hour group compared to the 0-3-hour group (28.4 vs. 21.4%, p = 0.09). A χ(2) test for trend demonstrated a rising proportion of symptomatic ICH in later time windows (p = 0.013). A similar trend (non-significant) was observed for mortality. Conclusion: Our study suggests that patients with acute ischemic stroke may be successfully treated with intravenous tPA in the 3-4.5-hour treatment window, but cautions that later time window treatment may result in greater adverse events. (Copyright © 2010 S. Karger AG, Basel.) |
| التعليقات: | Comment in: Cerebrovasc Dis. 2011;31(3):229. (PMID: 21178346) |
| المشرفين على المادة: | 0 (Fibrinolytic Agents) EC 3.4.21.68 (Tissue Plasminogen Activator) |
| تواريخ الأحداث: | Date Created: 20101224 Date Completed: 20110613 Latest Revision: 20210105 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1159/000321893 |
| PMID: | 21178345 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1421-9786 |
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| DOI: | 10.1159/000321893 |