Intravenous thrombolysis in ischemic stroke: clinical predictors of efficacy and safety

Abstract

Introduction. Systemic thrombolysis with recombinant tissue plasminogen activator is the “gold standard” of reperfusion therapy, having the maximum level of evidence in European and North American guidelines for the treatment of patients with acute ischemic stroke (IS). Objective: to determine factors of individual efficacy and safety of systemic thrombolysis in patients with IS aiming to establish personalized approach to its optimization. Materials and methods. The study included 396 patients with IS, of whom 196 patients underwent systemic thrombolysis with recombinant tissue plasminogen activator and 200 patients formed the control group. A prospective non-randomized study was conducted in parallel groups to estimate efficacy and safety of systemic thrombolysis with recombinant tissue plasminogen activator. The primary endpoint of the study was functional independence of patients measured with a modified Rankin scale 3 months after the stroke. Results. We confirmed improvement of the functional outcome in patients with IS who underwent systemic thrombolysis. We also showed no effect of thrombolytic therapy on the mortality rates. Decreased wakefulness, presence of aphasia, hemiplegia, congestive heart failure, type 2 diabetes, postinfarction cardiosclerosis were shown to be clinical factors associated with an unfavorable prognosis of the disease after systemic thrombolysis. We found higher likelihood of death in patients with decreased level of consciousness (OR 3.1 (1.1–8.8); p=0.03), as well as with paresis (OR 6.8 (2.2–20.9); p<0.001), hemiplegia (OR 6.5 (2.0–21.4); p=0.002), and chronic heart failure (OR 2.4 (1.1–5.3); p=0.03). Conclusion. Adequate analysis of neurological symptoms and clinical and anamnestic data upon admission of a patient with IS allows to predict the effectiveness of thrombolysis and may be important in treatment planning and in choosing reperfusion methods.