Abstract WP21: Safety And Feasibility Of Repeated Thrombolytic Therapy In Patients With Acute Ischemic Stroke
Background: Several studies reported that repeated thrombolysis in patients with myocardial infarction or pulmonary embolism is safe. There are scant reports about repeated thrombolysis in patients with acute stroke. Recently, mechanical thrombectomy showed promising results in recanalization of occluded cerebral artery. However, no studies so far have evaluated the safety and feasibility of repeated thrombolytic therapy in the era of multimodal thrombolytic treatments.
Methods: We investigated the patients with acute ischemic stroke who received thrombolytic therapy from Yonsei Stroke Registry for 10 years. The patients were divided into the repeated thrombolytic therapy group and the group who received thrombolysis once. Using propensity score to adjust for basic demographic, clinical, and treatment characteristics, we analyzed the rates of recanalization (Thrombolysis in Cerebral Infarction >=2), good outcome (modified Rankin Scale 0-2), and symptomatic intracranial hemorrhage.
Results: Of the 437 patients who received thrombolytic treatments (IV in 41.4%, intra-arterial in 19.7%, and multimodal treatments in 38.9%), repeated thrombolysis was undergone in 7 patients (1.6%). Median age of repeated thrombolytic therapy group was 67.5 years old (range 50 to 78) and three of them were males. The median time interval between first and repeated treatment was 1.3 years (range 6 days to 6 years). Median NIHSS score was 15 (IQR 10-20). Six patients (85.7%) of 7 repeated treatment group had atrial fibrillation. After propensity matching there was no significant difference between repeated thrombolytic treatment and single treatment groups in the recanalization rates (100% vs. 85.7%, p = 0.28), and good outcome at 3 months (71.43% vs. 57.14%, p = 0.655). No symptomatic intracranial hemorrhage was occurred in the repeated thrombolytic treatment group.
Conclusion: Repeated thrombolysis for chronologically separate acute ischemic stroke was rarely performed by the stroke team. Our data showed that repeated thrombolysis was safe and feasible.
- © 2012 by American Heart Association, Inc.