on May 7, 2009
Published online before print May 7, 2009, doi: 10.1161/STROKEAHA.108.538587
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Submitted on September 25, 2008
From the Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron and Universidad Autònoma de Barcelona, Spain. * To whom correspondence should be addressed. 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 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.
Revised on December 26, 2008
Accepted on January 28, 2009
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*;
2).
Key words: acute stroke • Doppler • thrombolysis • tPA • guidelines
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