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(Stroke. 2009;40:2568.)
© 2009 American Heart Association, Inc.

Research Letters

Is it Time to Reassess the SITS-MOST Criteria for Thrombolysis?

A Comparison of Patients With and Without SITS-MOST Exclusion Criteria

Marta Rubiera, MD, PhD; Marc Ribo, MD, PhD; Estevo Santamarina, MD, PhD; Olga Maisterra, MD; Raquel Delgado-Mederos, MD, PhD; Pilar Delgado, MD, PhD; Gemma Ortega; Jose Alvarez-Sabin, MD, PhD Carlos A. Molina, MD, PhD

From the Stroke Unit, Neurology Department, Hospital Universitari Vall d’Hebron and Universidad Autònoma de Barcelona, Spain.

Correspondence to Marta Rubiera, Unitat Neurovascular Hospital Vall d’Hebron, Barcelona, 08035 Spain. E-mail mrubifu{at}hotmail.com

Background and Purpose— The Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) established guidelines to increase safety in acute stroke thrombolysis, but precluding treatment in an important proportion of patients. We aimed to assess safety/efficacy of thrombolysis in patients with SITS-MOST exclusion criteria.

Methods— 369 nonlacunar tPA-treated patients were studied. Patients were classified as SITS-MOST (SM) or non–SITS-MOST (NSM) according to SITS-MOST–criteria fulfilling. Clinical evaluation was assessed by NIHSS and functional outcome by mRS at 3 months (functional independency=mRS 2).

Results— Baseline NIHSS was 17. 169 (45.8%) patients were SM and 200 (54.1%) NSM. Recanalization (47.6%/50.3%, P=0.36), 24-hour-improvement (55.6%/49.5%, P=0.114), and SICH were similar (4.8%/5.1%, P=0.554). At discharge, clinical improvement in SM-group was higher (66.7%/55.7%, P=0.024). NSM tended to higher mortality (10.5%/16.1%, P=0.084) and lower functional independence (48.7%/39.6%, P=0.082).

Conclusion— Thrombolysis may be safe in patients not fulfilling SITS-MOST criteria. Testing thrombolysis in patients outside SITS-MOST could be considered in the future.

Key Words: acute stroke • Doppler • thrombolysis • tPA • guidelines

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