title: Readministration of intravenous alteplase in acute ischemic stroke patients: case series and systematic review.
abstract: BACKGROUND
  Because of a high risk of recurrence of ischemic events, some patients may be candidates for readministration of intravenous (IV) alteplase.
  
  
  METHODS
  We performed a single-center review and performed a search on PubMed from January 1966 to April 2014 for cases of readministration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0 to 2 at discharge or at 1 to 3 months, improvement of greater than or equal to 4 points within 24 hours in the National Institutes of Health Stroke Scale score, or as a major improvement in the 72-hour National Institutes of Health Stroke Scale score.
  
  
  RESULTS
  Four ischemic stroke patients underwent readministration of IV alteplase in our single-center review. None of the patients had symptomatic or asymptomatic intracerebral hemorrhage.In 2 patients, IV alteplase had been administered for a previous acute ischemic stroke, 6 and 49 days before the index ischemic stroke.At discharge, both patients had a favorable outcome. A total of 22 cases of readministration of alteplase for ischemic stroke have been reported in literature. The mean interval between the 2 administrations of alteplase was 428 days (range, 3 hours to 2280 days).Asymptomatic post thrombolytic intracerebral hemorrhages were seen in 2 patients. Favorable outcome was seen in 16 patients. A total of 9 underwent readministration of IV alteplase within 3 months for recurrent ischemic stroke. Favorable outcome was seen in 5 of these 9 patients.
  
  
  CONCLUSIONS
  We observed a relatively high rate of favorable outcomes and a small rate of adverse events after readministration of IV alteplase in ischemic stroke patients.
authors.affiliation: Zeenat Qureshi Stroke Institute, 519 2nd St N, St Cloud, MN 56303. Electronic address: qureshai@gmail.com.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
authors.affiliation: Zeenat Qureshi Stroke Institute, 519 2nd St N, St Cloud, MN 56303. Electronic address: AhmedMalik1@yahoo.com.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Malik
authors.affiliation: CentraCare Health System, Department of Cerebrovascular Diseases and Interventional Neurology, St Cloud Hospital, 1406 6th Ave N, St Cloud, MN 56303. Electronic address: FreeseM@centracare.com.
authors.forename: Melissa
authors.initials: M
authors.lastname: Freese
authors.affiliation: CentraCare Health System, Department of Cerebrovascular Diseases and Interventional Neurology, St Cloud Hospital, 1406 6th Ave N, St Cloud, MN 56303. Electronic address: ThompsonMi@centracare.com.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Thompson
authors.affiliation: Zeenat Qureshi Stroke Institute, 519 2nd St N, St Cloud, MN 56303. Electronic address: asifk63@gmail.com.
authors.forename: Asif A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Zeenat Qureshi Stroke Institute, 519 2nd St N, St Cloud, MN 56303. Electronic address: fareedsuri@gmail.com.
authors.forename: M Fareed K
authors.initials: MF
authors.lastname: Suri
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020521:Stroke / Q000188:drug therapy*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator