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Clinical Summary

Seizure at stroke onset is not a reason to withhold thrombolysis

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).
  • 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


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