Abstract
Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effect of these therapies. Among 1,694 AIS patients, 805 patients were treated with intravenous thrombolysis, including patients with (n=793) or without (n=12) a history of cerebral hemorrhage, and the rate of incidence of SICH significantly differed between them (8.3 vs 4.3%, P=0.039). No significant difference was found in 90-d mRS measurements (41.7 vs 43.6%, P=0.530) and 90-d mortality rates (8.3 vs 6.5%, P=0.946). A total of 76 AIS patients with a history of cerebral hemorrhage received tPA thrombolytic therapy (n=12) or conventional therapy (n=64), and a significant difference was noted in the 90-d mRS scores between the two groups (41.7 vs 23.4%, P=0.029), while no significant difference was found in SICH measurements (8.3 vs 4.6%, P=0.610) and 90-d mortality rates (8.3 vs 9.4%, P=0.227). A history of cerebral hemorrhage is not an absolute contraindication for thrombolytic therapy; tPA intravenous thrombolysis does not increase SICH measurements and mortality rates in patients with a history of cerebral hemorrhage, and they may benefit from thrombolytic therapy.
Highlights
Acute ischemic stroke (AIS) is a major cause of death and disability in the United States [1]
1,694 AIS patients arrived at the hospital emergency department within 4.5 h of the onset of stroke, and 76 (4.5%) patients had a previous history of cerebral hemorrhage
Based on the contraindication in stroke guidelines, those 76 patients should not receive intravenous thrombolysis, regardless of the time interval of cerebral hemorrhage occurrence, bleeding site, bleeding volume, and recovery condition of cerebral hemorrhage. According to their family’s wishes, for some patients who had a cerebral hemorrhage long before and an optimal recovery, The use of alteplase (tPA) intravenous thrombolysis was used at a median tPA dose of 0.64 mg/kg
Summary
Acute ischemic stroke (AIS) is a major cause of death and disability in the United States [1]. Hypertension is a common risk factor for both ischemic and hemorrhagic strokes [2], and incidence of hypertensive intracerebral hemorrhage in the Asian population is higher than in Europe and the United States due to racial and dietary habits [3]. The use of alteplase (tPA) intravenous thrombolysis within 4.5 h of symptom onset during stroke is the only therapy that reduces disability among AIS patients [4]. The stroke guidelines of every country classify a history of intracranial hemorrhage as a contraindication for intravenous thrombolytic therapy [6,7]. Patients with a history of cerebral hemorrhage cannot receive intravenous thrombolysis, regardless of the location and amount of bleeding or recovery situation
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Schedule a callMore From: Brazilian journal of medical and biological research = Revista brasileira de pesquisas medicas e biologicas
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