TY - JOUR
T1 - Thrombolysis with Low-Dose Tissue Plasminogen Activator 3–4.5 h After Acute Ischemic Stroke in Five Hospital Groups in Japan
AU - Morihara, Ryuta
AU - Kono, Syoichiro
AU - Sato, Kota
AU - Hishikawa, Nozomi
AU - Ohta, Yasuyuki
AU - Yamashita, Toru
AU - Deguchi, Kentaro
AU - Manabe, Yasuhiro
AU - Takao, Yoshiki
AU - Kashihara, Kenichi
AU - Inoue, Satoshi
AU - Kiriyama, Hideki
AU - Abe, Koji
N1 - Funding Information:
This work was supported in part by Grants-in-Aid for Scientific Research (B) 2529320216 and (C) 24591263 and Grant-in-Aid for Challenging Research 24659651 from the Ministry of Education, Culture, Sports, Science and Technology, and by Grants-in-Aid from the Research Committees (H. Mizusawa, I. Nakano, M. Nishizawa, H. Sasaki, and M. Aoki) from the Ministry of Health, Labor and Welfare of Japan.
Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/4/1
Y1 - 2016/4/1
N2 - Clinical data from Japan on the safety and real-world outcomes of alteplase (tPA) thrombolysis in the extended therapeutic window are lacking. The aim of this study was to assess the safety and real-world outcomes of tPA administered within 3–4.5 h of stroke onset. The study comprised consecutive acute ischemic stroke patients (n = 177) admitted across five hospitals between September 2012 and August 2014. Patients received intravenous tPA within <3 or 3–4.5 h of stroke onset. Endovascular therapy was used for tPA-refractory patients. In the 3–4.5 h subgroup (31.6 % of patients), tPA was started 85 min later than the <3 h group (220 vs. 135 min, respectively). However, outcome measures were not significantly different between the <3 and 3–4.5 h subgroups for recanalization rate (67.8 vs. 57.1 %), symptomatic intracerebral hemorrhage (2.5 vs. 3.6 %), modified Rankin Scale score of 0–1 at 3 months (36.0 vs. 23.4 %), and mortality (6.9 vs. 8.3 %). We present data from 2005 to 2012 using a therapeutic window <3 h showing comparable results. tPA following endovascular therapy with recanalization might be superior to tPA only with recanalization (81.0 vs. 59.1 %). Compared with administration within 3 h of ischemic stroke onset, tPA administration within 3–4.5 h of ischemic stroke onset in real-world stroke emergency settings at multiple sites in Japan is as safe and has the same outcomes.
AB - Clinical data from Japan on the safety and real-world outcomes of alteplase (tPA) thrombolysis in the extended therapeutic window are lacking. The aim of this study was to assess the safety and real-world outcomes of tPA administered within 3–4.5 h of stroke onset. The study comprised consecutive acute ischemic stroke patients (n = 177) admitted across five hospitals between September 2012 and August 2014. Patients received intravenous tPA within <3 or 3–4.5 h of stroke onset. Endovascular therapy was used for tPA-refractory patients. In the 3–4.5 h subgroup (31.6 % of patients), tPA was started 85 min later than the <3 h group (220 vs. 135 min, respectively). However, outcome measures were not significantly different between the <3 and 3–4.5 h subgroups for recanalization rate (67.8 vs. 57.1 %), symptomatic intracerebral hemorrhage (2.5 vs. 3.6 %), modified Rankin Scale score of 0–1 at 3 months (36.0 vs. 23.4 %), and mortality (6.9 vs. 8.3 %). We present data from 2005 to 2012 using a therapeutic window <3 h showing comparable results. tPA following endovascular therapy with recanalization might be superior to tPA only with recanalization (81.0 vs. 59.1 %). Compared with administration within 3 h of ischemic stroke onset, tPA administration within 3–4.5 h of ischemic stroke onset in real-world stroke emergency settings at multiple sites in Japan is as safe and has the same outcomes.
KW - Acute stroke
KW - Edaravone
KW - Endovascular treatment
KW - Intracerebral hemorrhage
KW - Recanalization
KW - Tissue-type plasminogen activator
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U2 - 10.1007/s12975-016-0448-8
DO - 10.1007/s12975-016-0448-8
M3 - Article
C2 - 26815291
AN - SCOPUS:84959543782
VL - 7
SP - 111
EP - 119
JO - Translational Stroke Research
JF - Translational Stroke Research
SN - 1868-4483
IS - 2
ER -