Safety of Intravenous Thrombolysis in Stroke Mimics

Georgios Tsivgoulis, Ramin Zand, Aristeidis H. Katsanos, Nitin Goyal, Ken Uchino, Jason Chang, Efthimios Dardiotis, Jukka Putaala, Anne Alexandrov, Marc Malkoff, Andrei Alexandrov

Research output: Contribution to journalArticle

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Abstract

Background and Purpose - Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. Methods - We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Results - Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3-22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%-2%) and 0.3% (95% confidence interval, 0%-2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14-0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07-3.73; P<0.00001). Conclusions - Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM.

Original languageEnglish (US)
Pages (from-to)1281-1287
Number of pages7
JournalStroke
Volume46
Issue number5
DOIs
StatePublished - May 20 2015

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Stroke
Safety
Cerebral Hemorrhage
Meta-Analysis
Confidence Intervals
National Institutes of Health (U.S.)
Tertiary Care Centers
Edema
Odds Ratio
Publication Bias
Intravenous Administration
Needles

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Safety of Intravenous Thrombolysis in Stroke Mimics. / Tsivgoulis, Georgios; Zand, Ramin; Katsanos, Aristeidis H.; Goyal, Nitin; Uchino, Ken; Chang, Jason; Dardiotis, Efthimios; Putaala, Jukka; Alexandrov, Anne; Malkoff, Marc; Alexandrov, Andrei.

In: Stroke, Vol. 46, No. 5, 20.05.2015, p. 1281-1287.

Research output: Contribution to journalArticle

Tsivgoulis, G, Zand, R, Katsanos, AH, Goyal, N, Uchino, K, Chang, J, Dardiotis, E, Putaala, J, Alexandrov, A, Malkoff, M & Alexandrov, A 2015, 'Safety of Intravenous Thrombolysis in Stroke Mimics', Stroke, vol. 46, no. 5, pp. 1281-1287. https://doi.org/10.1161/STROKEAHA.115.009012
Tsivgoulis, Georgios ; Zand, Ramin ; Katsanos, Aristeidis H. ; Goyal, Nitin ; Uchino, Ken ; Chang, Jason ; Dardiotis, Efthimios ; Putaala, Jukka ; Alexandrov, Anne ; Malkoff, Marc ; Alexandrov, Andrei. / Safety of Intravenous Thrombolysis in Stroke Mimics. In: Stroke. 2015 ; Vol. 46, No. 5. pp. 1281-1287.
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AU - Uchino, Ken

AU - Chang, Jason

AU - Dardiotis, Efthimios

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AU - Malkoff, Marc

AU - Alexandrov, Andrei

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N2 - Background and Purpose - Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. Methods - We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of ≥4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Results - Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60±14 years; median National Institutes of Health Stroke scale, 11; range, 3-22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%-2%) and 0.3% (95% confidence interval, 0%-2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14-0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07-3.73; P<0.00001). Conclusions - Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM.

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