Abstract TMP24: Intravenous Thrombolysis For Acute Ischemic Stroke Occurring During Hospitalization For Transient Ischemic Attack: An International, Multicenter Study
Background&Purpose: There are limited data regarding the safety of intravenous thrombolysis (IVT) in patients who experienced acute ischemic stroke (AIS) during their hospitalization for Transient Ischemic Attack (TIA). We sought to prospectively evaluate the safety and efficacy of systemic thrombolysis in AIS occurring during hospitalization for TIA in an international, multi-center study
Subjects&Methods: Consecutive patients with AIS that occurred during hospitalization for prior TIA were treated with standard intravenous tissue plasminogen activator (tPA) at five tertiary-care stroke centers. Early arterial recanalization was determined by transcranial Doppler at the end of tPA infusion using the previously validated Thrombolysis in Brain Ischemia flow-grading system. Symptomatic intracranial hemorrhage complicating systemic thrombolysis was evaluated using NINDS rtPA Stroke Study definition. Functional outcome at three months was evaluated using the modified Rankin Scale (mRS).
Results: Systemic tPA (median onset-to-treatment time 70 min, interquartile range 50-150) was given in 25 consecutive patients (mean age 66±10years) who developed symptoms of acute stroke (median NIHSS-score 10 points; interquartile range 8-14) during hospitalization for prior TIA [(median ABCD2-score 5 points, median time-to-symptom recurrence 24 hrs, interquartile range 24-48). No symptomatic intracranial hemorrhage (0%; 95%CI:0-12%) was documented. Early complete recanalization occurred in 64% (95%CI:44%-80%) of the study population; 84% (95%CI:65%-94%) achieved three-month functional independence (mRS-score of 0-2). The rate of three-month functional independence was higher in patients treated with iv-tPA within 90 min from symptom onset compared to those with onset-to-treatment time>90 min (81% vs 33%; p=0.031)
Conclusions: Intravenous thrombolysis for symptoms of ischemic stroke occurring after hospitalization for TIA appears to be safe. These pilot data support re-setting the clock if new symptoms recur shortly after TIA.
- © 2012 by American Heart Association, Inc.