Takeaway
- Seizure at onset of ischaemic stroke does not independently predict poor outcomes in patients given intravenous thrombolysis.
Why this matters
- Seizure at onset is considered a relative contraindication for this treatment.
Key results
- 1.5% of patients had seizures at stroke onset.
- In unadjusted analysis, these patients generally had poorer outcomes.
- However, in further analyses, seizures at onset were not significantly associated with study outcomes:
- Symptomatic intracranial haemorrhage:
- ORadjusted, 0.52 (P=.37).
- ORmatched, 0.68 (P=.61).
- ORweighted, 0.95 (P=.97).
- 3-month mortality:
- ORadjusted, 0.98 (P=.95).
- ORmatched, 1.13 (P=.73).
- ORweighted, 1.17 (P=.83).
- Poor 3-month functional outcome: modified Rankin Scale score ≥3/ordinal modified Rankin Scale score:
- ORadjusted, 0.78 (P=.35)/0.78 (P=.22).
- ORmatched, 0.75 (P=.32)/0.45 (P=.3).
- ORweighted, 0.87 (P=.83)/1.00 (P=1.00).
- Symptomatic intracranial haemorrhage:
- Findings similar whether patients had eventual diagnosis of ischaemic stroke or stroke mimic.
Study design
- European multicentre, registry-based retrospective cohort study, 10,074 patients given intravenous thrombolysis for ischaemic stroke.
- Main outcomes: symptomatic intracranial haemorrhage (European Cooperative Acute Stroke Study II definition), mortality, functional outcome (modified Rankin Scale score).
- Funding: Wissenschaftspool, Medical Division, University Hospital Basel, Basel, Switzerland.
Limitations
- Outcomes not adjudicated.
- Lack of comparison group not treated with intravenous thrombolysis.
- Some patients with seizure at onset possibly excluded.
- Potential misclassification in patients with unwitnessed stroke.
References
References