Abstract WP70: Do Stroke Patients benefit from Thrombolysis despite Contraindications or Warnings?
Background&Purpose: Intravenous thrombolysis with alteplase is approved for acute ischemic stroke but its use is limited by numerous contraindications and warnings arising from trial selection criteria and/or expert opinions. We examined outcomes from alteplase-treated versus untreated patients from neuroprotectant trials held within a trials archive called VISTA, according to presence or absence of specified contraindications and warnings.
Subjects&Methods: We analysed 90 day modified Rankin scale across the whole distribution of scores using the Cochran-Mantel-Haenszel (CMH) test, with adjustment for age and baseline NIHSS, followed by proportional odds logistic regression analysis to estimate the odds ratios for preferred outcome. We gathered data from 9613 ischemic stroke patients, of whom 4793 patients (49.6%; 1281 thrombolysed, 3512 non-thrombolysed) had at least one known contraindication, and 6231 (64.8%; 1946 thrombolysed, 4285 non-thrombolysed) had at least one known contraindication or warning for treatment with alteplase.
Results: A broad trend of more favourable 3-month outcome associated with alteplase treatment in various subgroups of patients with contraindications or warnings was evident; eg in patients aged >80 (n=1805; OR 1.40; 95% CI 1.14-1.70; p <0.001), with combined history of prior stroke and diabetes (n=672; OR 1.50; 1.03-2.18; p=0.03), on prior single antiplatelet agent (n=1626; OR 1.42; 1.19-1.70; p 180 mg/dl (n=879; OR 1.50; 1.15-1.97; p=0.002) or with major early computed tomographic changes (n=176; OR 2.46; 1.28-4.72; p=0.01). Results were inconclusive after mild stroke, NIHSS<6 (n=381; OR 0.97; 0.50-1.87; p=0.76).
Conclusions: This retrospective analysis of various contraindications and warnings provides reassurance about benefits and risks of intravenous alteplase treatment in common clinical situations.
- © 2012 by American Heart Association, Inc.