Stroke, Vol 24, 587-590, Copyright © 1993 by American Heart Association
WT Longstreth Jr, PE Litwin and WD Weaver
BACKGROUND: Thrombolytic therapy used in patients with acute myocardial
infarction may increase the risk of stroke. Scant information is available
from community-based studies. SUMMARY OF REPORT: Among 5,635 consecutive
patients admitted with acute myocardial infarction to hospitals in Seattle
and surrounding suburban King County, Washington, 116 (2.1%) experienced
strokes during hospitalization. Of these strokes, 82 (71%) were ischemic
and 34 (29%) were hemorrhagic, defined by a patient's having had a computed
tomographic scan of the head that showed blood. Thrombolytic therapy was
given to 1,413 of these patients (25%) and was associated with increased
risk of hemorrhagic stroke but reduced risk of ischemic stroke. The
relative risk of stroke with thrombolytic therapy was estimate using
multiple logistic regression to adjust for potential confounding factors.
The adjusted relative risk for hemorrhagic stroke was 3.6 (95% confidence
interval [CI], 1.7-8.0); for ischemic stroke, 0.4 (95% CI, 0.2-0.9); and
for overall stroke, 1.0 (95% CI, 0.6-1.7). The adjusted risk for death from
any cause following stroke was 3.0 (95% CI, 1.4-6.4). CONCLUSIONS: Although
thrombolytic therapy had little effect on the overall occurrence of stroke,
thrombolytic therapy increased the risk of stroke death because more
patients with hemorrhagic than ischemic strokes died during their
hospitalization. The rates of hemorrhagic stroke with thrombolytic therapy
reported in the present study are higher than those reported in clinical
trials in which treatment is given to select patients under strict
protocols.
ARTICLES
Myocardial infarction, thrombolytic therapy, and stroke. A community- based study. The MITI Project Group
Department of Medicine, University of Washington, Seattle.
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