title: Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study.
abstract: OBJECTIVE
  Data on long-term outcome after intravenous tissue-type plasminogen activator (tPA) in ischemic stroke are limited. We examined the risk of long-term mortality, recurrent ischemic stroke, and major bleeding, including intracranial and gastrointestinal bleeding, in intravenous tPA-treated patients when compared with intravenous tPA eligible but nontreated patients with ischemic stroke.
  
  
  METHODS
  We conducted a register-based nationwide propensity score-matched follow-up study among patients with ischemic stroke in Denmark (2004-2011). Cox regression analysis was used to compute adjusted hazard ratios for all outcomes.
  
  
  RESULTS
  Among 4292 ischemic strokes (2146 intravenous tPA-treated and 2146 propensity score-matched nonintravenous tPA-treated patients), with a follow-up for a median of 1.4 years, treatment with intravenous tPA was associated with a lower risk of long-term mortality (adjusted hazard ratio, 0.66; 95% confidence interval, 0.49-0.88). The long-term risk of recurrent ischemic stroke (adjusted hazard ratio, 1.05; 95% confidence interval, 0.68-1.64) and major bleeding (adjusted hazard ratio, 0.59; 95% confidence interval, 0.24-1.47) did not differ significantly between the intravenous tPA-treated and nontreated patients.
  
  
  CONCLUSIONS
  Treatment with intravenous tPA in patients with ischemic stroke was associated with improved long-term survival.
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.). mariesch@rm.dk.
authors.forename: Marie Louise
authors.initials: ML
authors.lastname: Schmitz
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Claus Z
authors.initials: CZ
authors.lastname: Simonsen
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Heidi
authors.initials: H
authors.lastname: Hundborg
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Hanne
authors.initials: H
authors.lastname: Christensen
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Karsten
authors.initials: K
authors.lastname: Ellemann
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Karin
authors.initials: K
authors.lastname: Geisler
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Helle
authors.initials: H
authors.lastname: Iversen
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Charlotte
authors.initials: C
authors.lastname: Madsen
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Mary-Jette
authors.initials: MJ
authors.lastname: Rasmussen
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Karsten
authors.initials: K
authors.lastname: Vestergaard
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Grethe
authors.initials: G
authors.lastname: Andersen
authors.affiliation: From the Department of Neurology, Aarhus University Hospital, Aarhus C, Denmark (M.L.S., C.Z.S., G.A.); Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark (H.H., S.P.J.); Department of Neurology, Bispebjerg Hospital, Copenhagen, Denmark (H.C.); Department of Neurology, Roskilde Hospital, Roskilde, Denmark (K.E.); Department of Neurology, Holstebro Hospital, Holstebro, Denmark (K.G.); Department of Neurology, Glostrup Hospital, Glostrup, Denmark (H.I.); Department of Neurology, Odense University Hospital, Odense C, Denmark (C.M.); Department of Neurology, Esbjerg Hospital, Esbjerg, Denmark (M.-J.R.); and Department of Neurology, Aalborg University Hospital, Aalborg, Denmark (K.V.).
authors.forename: Soeren P
authors.initials: SP
authors.lastname: Johnsen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003718:Denmark; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D020521:Stroke / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: mortality; therapeutic thrombolysis; tissue-type plasminogen activator