Systemic Thrombolysis Data from the German Stroke Database
Objectives: To present data on systemic thrombolysis for acute ischemic stroke from a cooperative database of 23 german hospitals. Methods: All admitted stroke patients in the participating centers were prospectively recruited into a 599-item database including a telephone follow-up 3 months after stroke. Findings: From 01/1998 until 11/1999, 5279 patients with acute ischemic stroke were included in the database, 205 (3.9%) had systemic thrombolysis with 0.9mg/kg rt-PA (alteplase). Three hospitals did not perform thrombolysis (range of thrombolysis rate 0–11.3%). The median age of patients was 63 years (41% female, 59% male). The median National Institutes of Health Stroke Scale Score (NIHSSS) at admission was 14. Early high dose intravenous heparin after thrombolysis was given to 61.2% of patients. The rate of intracranial parenchymal hematoma (PH) until day 3 was 6.8%. In a logistic regression model including age, hypertension before stroke, NIHSSS, level of consciousness at admission, TOAST-classification, delay of thrombolysis and high dose intravenous heparin after thrombolyisis, PH was independently associated with high dose intravenous heparin after thrombolysis (p=.031) and hypertension before stroke (p=.042). Decompressive surgery was performed in 4.4% of thrombolysis patients. The median length of stay in the documenting hospital was 13 days, 4 in the ASU and 3 in the ICU. After 90 days, a Modified Rankin Scale Score (MRS) ≤1 was observed in 26.8%, ≤2 in 42.5% of patients (follow-up rate 66%). The mortality until day 90 was 18.3%. Conclusions: These uncontrolled multicenter data confirm published data on the frequency of use of systemic thrombolysis, risk of (symptomatic) PH and 3-month-mortality. The percentage of patients with favorable outcome (MRS ≤1) is lower than in the controlled trials. Early secondary prevention with high dose i.v. heparin was associated with increased frequency of PH and should therefore be avoided.