Ischemic stroke: alteplase boosts long-term survival, function

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Takeaway

  • Among patients with ischemic stroke, intravenous thrombolysis with alteplase (Activase) extended survival an average of 1 year over the subsequent decade.

Why this matters

  • Trials of intravenous thrombolysis have had a limited follow-up.

Key results

  • Patients undergoing thrombolysis had longer median survival than control patients (5.72 vs 4.98 years; P<.001).
  • Number needed to treat to prevent 1 death at 10 years was 20.
  • Thrombolysis netted more than one-third reduction in risk for death at 10 years (HR, 0.63; 95% CI, 0.48-0.82).
  • Benefit increased with multiplicative interaction term and analysis among patients arriving at hospital ≤3 hours (HR, 0.58; 95% CI, 0.40-0.82).
  • Thrombolysis increased 5-year likelihood of independence (OR, 3.76; 95% CI, 1.22-13.34) and higher Frenchay Activities Index (proportional OR, 2.37; 95% CI, 1.16-4.91).
  • Recurrence risk did not differ between groups.

Study design

  • Population-based registry study of 246 patients with first-ever ischemic stroke who underwent thrombolysis and 492 propensity-matched control patients who did not.
  • Main outcome: survival up to 10 years (median follow-up, 5.45 years).
  • Funding: NIHR Collaboration for Leadership in Applied Health Research and Care South London; Royal College of Physicians; NIHR Biomedical Research Centre.

Limitations

  • Residual confounding.
  • Missing data.
  • Time of thrombolysis unknown.