Intravenous Alteplase Raises Ischemic Stroke Survival

A new study also warns that ischemic stroke patients who do not receive intravenous (IV) alteplase are significantly less likely to survive.

Researchers at Georgia State University (GSU; Atlanta, USA), the Georgia Department of Public Health (Atlanta, USA), and other institutions reviewed the 2008–2013 Georgia Coverdell Acute Stroke Registry data, which was then linked with 2008–2013 hospital discharge records and 2008–2014 death data in the state of Georgia (USA). The aim of the study was to assess the impact of thrombolytic treatment by IV alteplase on one-year mortality and readmission rates among acute ischemic stroke patients.

The results revealed that that 9,620 people underwent acute ischemic stroke during the study period. Of these, 20.3% of patients died and 22.4% were readmitted within the year. Analysis showed that patients who did not receive IV alteplase had a 49% higher risk of dying at one year than those who were treated with the thrombolytic agent. Among patients who were discharged, no statistically significant difference was documented in the odds of being readmitted at least once within 365 days of post-stroke discharge. The study was published on July 31, 2017, in the American Journal of Emergency Medicine.

“Clinicians may be hesitant to administer IV alteplase because of concerns about the drug's complications, which can include bleeding,” said lead author Moges Ido, MD, of GSU. “But this study indicates that unless major contraindications are present, patients should be offered this treatment as a life-saving measure.”

IV alteplase administered within 4.5 hours of symptom onset is the only reperfusion therapy with proven efficacy in patients with acute ischemic stroke. However, well-recognized limitations of this therapy include the narrow therapeutic time window and contraindications such as recent surgery, coagulation abnormalities, and a history of intracranial hemorrhage. Moreover, IV alteplase appears to be much less effective at opening proximal occlusions of the major intracranial arteries, which account for more than one-third of cases of acute anterior-circulation stroke.

Related Links:
Georgia State University
Georgia Department of Public Health