Thrombolysis beneficial for stroke, even with preexisting disabilities

Takeaway

• Among patients with acute ischaemic stroke, intravenous thrombolysis improved functional outcome even in those having preexisting disabilities, provided they were not bedridden.

Why this matters

• This population is often excluded from receiving intravenous thrombolysis.

Key results

• Receipt of intravenous thrombolysis by prestroke Rankin Scale score:
  • 32% among patients with score of 0-1.
  • 20% among patients with score of 2-5.
• Intravenous thrombolysis improved odds of returning to baseline prestroke Rankin Scale score (or modified Rankin Scale score of 0 or 1) across most prestroke scores (aOR; 95% CI):
  • Score of 0 (1.73; 1.61-1.86).
  • Score of 1 (1.49; 1.24-1.78).
  • Score of 2 (1.42; 1.16-1.73).
  • Score of 3 (1.57; 1.24-1.99).
  • Score of 4 (1.60; 1.13-2.27).
• But it did not confer benefit among patients with prestroke score of 5.
• Intravenous thrombolysis did not significantly increase risk for in-hospital mortality in any prestroke Rankin Scale score subgroup.

Expert comment

• In an editorial, Mona N. Bahouth, MD, and Didier Leys, MD, PhD, write, “Collectively, these data suggest that administering thrombolytic therapy to patients with acute stroke with higher prestroke Rankin Scale score is safe and reasonable. Whether these conclusions generalise to endovascular therapy warrants investigation.”

Study design

• German observational cohort study of 52,741 patients with acute ischaemic stroke admitted in window of potential eligibility for intravenous thrombolysis (<4.5 hours after stroke onset).
• Main outcome: functional outcome at discharge.
• Funding: Department of Neurology, University of Heidelberg.

Limitations

• Reliance on hospital records.
• Possible bias in patients hospitalised.
• Heterogeneity of stroke care.
• Lack of detailed information on intracranial haemorrhages.