title: Low body temperature does not compromise the treatment effect of alteplase.
abstract: OBJECTIVE
  Hypothermia is neuroprotective in ischemic stroke models. The influence of baseline body temperature on outcomes after thrombolytic therapy is unclear. We examined outcomes after alteplase treatment across baseline body temperature for patients with ischemic stroke in data held within the Virtual International Stroke Trials Archive (VISTA; 1998 to 2007).
  
  
  METHODS
  We collated data on age, baseline severity (National Institutes of Health Stroke Scale), and 90-day modified Rankin Scale score on patients presenting with acute ischemic stroke. We compared 90-day modified Rankin Scale score between thrombolyzed and nonthrombolyzed comparators across baseline body temperature. We report age and baseline National Institutes of Health Stroke Scale-adjusted Cochran-Mantel-Haenszel probability value and proportional OR with 95% CI for improved modified Rankin Scale distribution. We report temperature profiles over 72 hours after stroke by treatment group.
  
  
  RESULTS
  Rankin data were available for 5586 patients with acute ischemic stroke in VISTA (1980 received alteplase). Age and baseline severity were similar (age 68.0±13.0 years versus 69.9±12.3 years, National Institutes of Health Stroke Scale 14.2±5.2 versus 13.0±5.6). Alteplase was associated with improved outcome (OR, 1.49; 95% CI, 1.35 to 1.65, P<0.0001). Alteplase treatment effect was not associated with baseline temperature (P=0.14). Point estimates showed benefit of alteplase treatment across 35.5°C to 37.5°C but showed a negative trend >37.5°C. Alteplase did not influence temperature profiles over 72 hours after stroke.
  
  
  CONCLUSIONS
  There is no evidence of influence of body temperature on alteplase treatment response. These results are reassuring that low temperatures across a physiological range do not compromise therapeutic effect of alteplase.
authors.affiliation: Department of Medicine and Therapeutics, Western Infirmary and Faculty of Medicine, University of Glasgow, 44 Church Street, Glasgow G11 6NT, Scotland. 0808124@clinmed.gla.ac.uk
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Lees
authors.forename: Nishant K
authors.initials: NK
authors.lastname: Mishra
authors.forename: Monica
authors.initials: M
authors.lastname: Saini
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Lyden
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D002545:Brain Ischemia / Q000188:drug therapy* / Q000503:physiopathology; D002986:Clinical Trials as Topic; D016208:Databases, Factual; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D007035:Hypothermia; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000188:drug therapy* / Q000503:physiopathology; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator