Document Detail


Thrombolytic therapy for acute ischemic stroke after recent transient ischemic attack.
MedLine Citation:
PMID:  22098785     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM: Safety and efficacy of intravenous thrombolysis in stroke patients with recent transient ischemic attack are hotly debated. Patients suffering transient ischemic attack may present with diffusion-weighted imaging lesions, and although normal computed tomography would not preclude thrombolysis, the concern is that they may be at higher risk for hemorrhage post-thrombolysis treatment. Prior ipsilateral transient ischemic attack might provide protection due to ischemic preconditioning. We assessed post-thrombolysis outcomes in stroke patients who had prior transient ischemic attack.
METHODS: Multicentered prospective study of consecutive acute stroke patients treated with intravenous tissue plasminogen activator (tPA). Ipsilateral transient ischemic attack, baseline characteristics, risk factors, etiology, and time-lapse to treatment were recorded. National Institutes of Health Stroke Scale at seven-days and modified Rankin Scale at three-months, symptomatic intracranial hemorrhage, and mortality were compared in patients with and without transient ischemic attack.
RESULTS: There were 877 patients included, 60 (6·84%) had previous ipsilateral transient ischemic attack within one-month prior to the current stroke (65% in the previous 24 h). Transient ischemic attack patients were more frequently men (70% vs. 53%; P = 0·011), younger (63 vs. 71 years of age; P = 0·011), smokers (37% vs. 25%; P = 0·043), and with large vessel disease (40% vs. 25%; P = 0·011). Severity of stroke at onset was similar to those with and without prior transient ischemic attack (median National Institutes of Health Stroke Scale score 12 vs. 14 P = 0·134). Those with previous transient ischemic attack were treated earlier (117 ± 52 vs. 144 ± 38 mins; P < 0·005). After adjustment for confounding variables, regression analysis showed that previous transient ischemic attack was not associated with differences in stroke outcome such as independence (modified Rankin Scale 0-2) (odds ratios: 1·035 (0·57-1·93) P = 0·91), mortality (odds ratios: 0·99 (0·37-2·67) P = 0·99), or symptomatic intracranial hemorrhage (odds ratios: 2·04 (0·45-9·32) P = 0·36).
CONCLUSIONS: Transient ischemic attack preceding ischemic stroke does not appear to have a major influence on outcomes following thrombolysis. Patients with prior ipsilateral transient ischemic attack appear not to be at higher risk of bleeding complications.
Authors:
María Alonso de Leciñana; Blanca Fuentes; Jaime Masjuan; Patricia Simal; Fernando Díaz-Otero; Gemma Reig; Exuperio Díez-Tejedor; Antonio Gil-Nuñez; Jose Vivancos; Jose-Antonio Egido
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2011-11-09
Journal Detail:
Title:  International journal of stroke : official journal of the International Stroke Society     Volume:  7     ISSN:  1747-4949     ISO Abbreviation:  Int J Stroke     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-03-12     Completed Date:  2012-09-13     Revised Date:  2014-02-03    
Medline Journal Info:
Nlm Unique ID:  101274068     Medline TA:  Int J Stroke     Country:  England    
Other Details:
Languages:  eng     Pagination:  213-8     Citation Subset:  IM    
Copyright Information:
© 2011 The Authors. International Journal of Stroke © 2011 World Stroke Organization.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Brain Ischemia / drug therapy*,  epidemiology
Female
Hemorrhage / chemically induced,  epidemiology
Humans
Ischemic Attack, Transient / drug therapy*,  epidemiology
Male
Middle Aged
Prospective Studies
Stroke / drug therapy*,  epidemiology
Thrombolytic Therapy* / adverse effects
Time Factors
Tissue Plasminogen Activator / administration & dosage,  adverse effects
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
Int J Stroke. 2013 Apr;8(3):E5   [PMID:  23489670 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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