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