title: Mortality in patients treated by intra-venous thrombolysis for ischaemic stroke.
abstract: In patients treated by intravenous (i.v.) thrombolysis, mortality rates range from 10 to 20 % at 3 months. The objective of this study was to determine the timing, causes and predictors of early (within 7 days) and delayed (8 days to 3 months) death after i.v. thrombolysis for cerebral ischaemia. We analyzed timing, causes and predictors of early and delayed mortality in a hospital-based registry of consecutive patients treated by i.v. thrombolysis for cerebral ischaemia. Of 500 patients (246 men; median age 71 years; median baseline National Institutes of Health Stroke Scale score 12; median onset-to-needle time 148 min), 76 (15.2%; 95% confidence interval [CI]: 12.3-18.6%) died within 3 months. Of 29 patients with early death, 21 (72.4%; 95% CI: 54.3-85.3%) died from neurovascular causes. Factors independently associated with early death were neurological complications and having had transient ischaemic attacks within the last 7 days. Of 47 patients with delayed death, 24 (51.1%; 95 % CI: 37.2-64.7%) died from infection, all but 1 having a modified Rankin scale >4 at 7 days. Factors independently associated with delayed death were pre-existing conditions and infections. Early and delayed mortality in ischaemic stroke patients are is highly dependent on the neurological status and response to thrombolysis. The target for reducing mortality is therefore to improve response to thrombolysis by any means, which can currently be achieved only by reducing delays.
authors: Department of Neurology, Lille University Hospital, Université Lille Nord de France, UDSL, EA, 1046, Lille, France.
authors: Loubna
authors: L
authors: Majhadi
authors: Didier
authors: D
authors: Leys
authors: Marie
authors: M
authors: Bodenant
authors: Hilde
authors: H
authors: Hénon
authors: Régis
authors: R
authors: Bordet
authors: Charlotte
authors: C
authors: Cordonnier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality*; D015912:Thrombolytic Therapy / Q000401:mortality*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
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