Outcome of Repeated Thrombolysis in Debrecen Thrombolysis Database.
BACKGROUND
Recombinant tissue plasminogen activator (rtPA) is an efficient therapy of acute ischemic stroke. The risk of a recurrent ischemic stroke is high. This prospective single center study aimed to assess whether or not the repeated rtPA treatment is beneficial for acute stroke patients.


METHODS
All thrombolysed patients' data at the Department of Neurology, University of Debrecen have been recorded in the Debrecen Thrombolysis Database (DTD) since 2004. We identified 21 patients with repeated thrombolysis. Stroke severity by the NIH stroke scale score (NIHSSS) and imaging findings by the Alberta Stroke Programme Early CT Score were evaluated on admission and 1 day later. The modified Rankin Scale score at 3 months and case fatality at 1 year were evaluated. We compared the first and second thrombolyses, and we screened for bleeding and allergic reactions to determine safety.


RESULTS
Within the 27-month median time, 18 patients were thrombolysed twice, with complete follow-up. In recurrent stroke patients, diabetes mellitus, congestive heart failure, and anticoagulation were more common. Admission cholesterol levels were decreased. After the first and second treatments, 24-hour NIHSSS were 3 (1;6) and 7 (1;10), respectively. At 3 months, good outcome was significantly higher after the first treatment than those of DTD, with no differences between the 2 attempts. There was little difference in 3-month and 1-year outcomes, regardless of laterality-ipsilateral or contralateral hemisphere-in recurrent strokes. One patient had nonsymptomatic intracranial bleeding after repeated rtPA treatment.


CONCLUSIONS
Recurrent rtPA treatment may be safe and effective in patients who have mild or moderate residual symptoms after the index stroke.
Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary. Electronic address: feketek@med.unideb.hu.
Klára
K
Fekete
Department of Sociology and Social Politics, Institute of Political Sciences and Sociology, Faculty of Arts and Humanities, University of Debrecen, Hungary.
Sándor
S
Márton
Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary.
László
L
Csiba
Department of Neurology, Faculty of Medicine, University of Debrecen, Hungary.
István
I
Fekete
D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D016208:Databases, Factual / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D015898:Tomography Scanners, X-Ray Computed; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
Recurrent ischemic stroke; outcome; repeated thrombolysis; symptomatic intracranial hemorrhage