title: Intravenous thrombolysis with rt-PA for acute ischemic stroke within 24h of a transient ischemic attack.
abstract: BACKGROUND
  Intravenous thrombolysis (iv-thrombolysis) with the use of rt-PA in patients after recent transient ischemic attack (TIA) is an important clinical problem. The aim of the study was to assess the impact of TIA within 24h preceding acute ischemic stroke (AIS) on the safety and efficacy of iv-thrombolysis.
  
  
  METHODS
  We retrospectively evaluated the clinical and demographic data of 400 patients with AIS who were consecutively treated with iv-thrombolysis from September 2006 to May 2011 in three stroke centers.
  
  
  RESULTS
  At three-month follow-up, 58.0% of patients were independent (modified Rankin scale; mRS 0-2), 17.8% had died, 17.0% suffered hemorrhagic transformation (HT) and 4.3% experienced symptomatic intracerebral hemorrhage (SICH). There were 29 patients (7.3%) who had a previous ipsilateral TIA within 24h before established stroke. In the TIA subgroup, there was no significant higher percentage of favorable outcome (p=0.07) and higher SICH rate (p=0.15). Multivariate analysis showed the impact of prior TIA within 24h before stroke onset in the presence of SICH (p=0.01), no impact of TIA on unfavorable outcomes after three months (p=0.25) and on the mortality rate within three months (p=0.41).
  
  
  CONCLUSIONS
  TIA within 24h prior to ischemic stroke can portend severe intracerebral bleeding in patients qualified to iv-thrombolysis with the use of rt-PA.
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland. Electronic address: piotrsobolewski@poczta.onet.pl.
authors.forename: Piotr
authors.initials: P
authors.lastname: Sobolewski
authors.affiliation: Department of Neurology and Stroke Unit, Saint Luke's Hospital in Końskie, Końskie, Poland.
authors.forename: Waldemar
authors.initials: W
authors.lastname: Brola
authors.affiliation: Department of Neurology and Stroke Unit, Hospital in Piła, Piła, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Wiszniewska
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
authors.forename: Wiktor
authors.initials: W
authors.lastname: Szczuchniak
authors.affiliation: Department of Neurology and Stroke Unit, Saint Luke's Hospital in Końskie, Końskie, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Fudala
authors.affiliation: Department of Neurology and Stroke Unit, Hospital in Piła, Piła, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Domagalski
authors.affiliation: Department of Neurology and Stroke Unit, Holy Spirit Specialist Hospital in Sandomierz, Sandomierz, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Sledzińska-Dźwigał
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D007839:Functional Laterality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D007275:Injections, Intravenous; D002546:Ischemic Attack, Transient / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Efficacy; Safety; Transient ischemic attack; iv-thrombolysis; rt-PA