Thrombolysis in patients with mild stroke: results from the Austrian Stroke Unit Registry.
OBJECTIVE
Apart from missing the approved time window of 4.5 hours, one frequent cause for withholding recombinant tissue plasminogen activator (rt-PA) treatment in patients with ischemic stroke is presentation with mild deficit on admission. We analyzed in a large cohort of patients whether rt-PA treatment is beneficial for this group of patients.


METHODS
From a total of 54 917 patients with ischemic stroke prospectively enrolled in the Austrian Stroke Unit Registry, 890 patients with mild deficit defined as ≤5 points in the National Institutes of Health Stroke Scale treated with and without rt-PA were matched for age, sex, prestroke disability, stroke severity, hypertension, diabetes mellitus, hypercholesterolemia, stroke cause, and clinical stroke syndrome. Functional outcome was assessed using the modified Rankin Scale at 3 months. For data visualization, weighted averages of outcome differences were computed for all age severity combinations and mapped to a color. For quantification of effect sizes, numbers need to treat were calculated.


RESULTS
rt-PA-treated patients with mild deficit had a better outcome after 3 months compared with matched cases without rt-PA treatment (odds ratio [OR], 1.49; 95% confidence interval [CI], 1.17-1.89; P<0.001). In rt-PA-treated patients with mild deficit, the numbers need to treat ranged from 8 to 14. Improvement achieved by rt-PA treatment was observed along the entire age range.


CONCLUSIONS
In our study, intravenous rt-PA treatment was beneficial for patients with mild deficit. Given the observational nature of these results, our data might serve as an incentive for future randomized controlled trials to provide a basis for optimal patient selection.
From the Department of Neurology, Medical University of Vienna, Vienna, Austria (S.G.); Danube University Krems and Gesundheit Österreich GmbH/BIQG, Vienna, Austria (L.S.); Department of Neurology, Innsbruck Medical University, Innsbruck, Austria (S.K.); and Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (W.L., J.F.).
Stefan
S
Greisenegger
Leonhard
L
Seyfang
Stefan
S
Kiechl
Wilfried
W
Lang
Julia
J
Ferrari
D000368:Aged; D001317:Austria; D016001:Confidence Intervals; D003627:Data Interpretation, Statistical; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012042:Registries; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
infarction; stroke; thrombolytic therapy