Is it time to reassess the SITS-MOST criteria for thrombolysis?: A comparison of patients with and without SITS-MOST exclusion criteria.
OBJECTIVE
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 <or=2).


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).


CONCLUSIONS
Thrombolysis may be safe in patients not fulfilling SITS-MOST criteria. Testing thrombolysis in patients outside SITS-MOST could be considered in the future.
Neurology Department, Hospital Universitari Vall d'Hebron, Universidad Autònoma de Barcelona, Spain. mrubifu@hotmail.com
Marta
M
Rubiera
Marc
M
Ribo
Estevo
E
Santamarina
Olga
O
Maisterra
Raquel
R
Delgado-Mederos
Pilar
P
Delgado
Gemma
G
Ortega
Jose
J
Alvarez-Sabin
Carlos A
CA
Molina
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents