Abstract T P193: Neurological Deterioration Within the First 24-hours After Fibrinolysis is Not as Frequent as Previously Reported in Stroke Patients

Abstract

Background: Studies have reported neurological detoriation at 24 hours in 20- 40% of patients with symptoms of ischemic stroke. Aim: To asses the frequency of neurological deterioration in patients after fibrinolysis. Methods: A prospective single hospital registry was based on 481 unselected consecutive patients admitted from July 2009- December 2011 with symptoms of acute ischemic stroke within 4.5 hours from symptom onset. Patients fulfilling international guidelines were treated with i.v tPA. Clinical status was assessed by National Institute of Health Stroke Scale (NIHSS) and Computerized Tomography was conducted at admission in all 481 patients and at 24 hours in patients treated with i.v tPA to assess neurological as well as radiological status. Patients were stratified as having neurological deterioration of 1, 2, 3 or > 3 NIHSS points. Results: Three-hundred and twenty three (67.2%) of the admitted stroke patients were treated with i.v tPA (median NIHSS 7, 1-42). At 24 hours, neurological detoriation was observed in 24 of the treated patients (7.4 %) (ΔNIHSS median +2; 1-9). Eleven patients had ΔNIHSS=+1, 3 patients had ΔNIHSS=+2, 4 patients had ΔNIHSS=+3 and 6 patients had ΔNIHSS>+3.Any degree of haemorrhagic transformation was detected in 28 (8.7 %) of the patients treated with i.v tPA (median ΔNIHSS -1.5; -10 - +4), of which 3 were symptomatic (0.9%) (median ΔNIHSS +2, 1-4). Neurological deterioration occurred significantly more often in patients admitted with moderat-severe stroke (p=0.003) and in patients with large vessel occlusions (p=0.041). Conclusion: The neurological deterioration observed in patients treated with i.v tPA was modest and less frequent than previous reported in patients with symptoms of acute stroke prior to general implementation of thrombolysis. Deteriation due to haemorrhagic transformation was rare and of limited scale in this population. If this phenomena is due to better care, selection of patients for treatment in accordance with international guidelines or due to an unknown effect caused by tPA is uncertain.