Martin-Schild Sheryl, Albright Karen C, Misra Vivek, Philip Maria, Barreto Andrew D, Hallevi Hen, Grotta James C, Savitz Sean I
Stroke. 2009 Nov;40(11):3635-7. doi: 10.1161/STROKEAHA.109.559823. Epub 2009 Sep 10.
The safety of thrombolytic therapy in patients with cocaine-associated acute ischemic stroke (CIS) is unknown.
We conducted a retrospective review of patients with CIS who presented to our stroke center. Thrombolytic treatment was compared between cocaine-positive (n=29) and cocaine-negative (n=75) patients. We also compared patients with CIS treated with tissue plasminogen activator versus those who did not receive tissue plasminogen activator (n=58). Safety outcomes were determined by the incidence of symptomatic intracerebral hemorrhage, in-hospital mortality, and modified Rankin Scale at hospital discharge.
There were no complications in tissue plasminogen activator-treated patients with CIS. Cocaine-positive and cocaine-negative treated patients had similar stroke severity and safety outcomes. Patients with CIS treated with tissue plasminogen activator had more severe strokes on baseline National Institutes of Health Stroke Scale but similar safety outcomes compared with nontreated patients with CIS.
Thrombolytic therapy for CIS appears to be safe in this small study. Further research is needed to more definitively assess safety and efficacy of tissue plasminogen activator for CIS.
可卡因相关性急性缺血性卒中（CIS）患者接受溶栓治疗的安全性尚不清楚。
我们对到我们卒中中心就诊的CIS患者进行了一项回顾性研究。比较了可卡因检测阳性（n = 29）和可卡因检测阴性（n = 75）患者的溶栓治疗情况。我们还比较了接受组织型纤溶酶原激活剂治疗的CIS患者与未接受组织型纤溶酶原激活剂治疗的患者（n = 58）。通过症状性脑出血的发生率、住院死亡率和出院时的改良Rankin量表来确定安全性结果。
接受组织型纤溶酶原激活剂治疗的CIS患者未出现并发症。可卡因检测阳性和检测阴性的治疗患者具有相似的卒中严重程度和安全性结果。与未接受治疗的CIS患者相比，接受组织型纤溶酶原激活剂治疗的CIS患者在基线国立卫生研究院卒中量表上的卒中更严重，但安全性结果相似。
在这项小型研究中，CIS的溶栓治疗似乎是安全的。需要进一步研究以更明确地评估组织型纤溶酶原激活剂治疗CIS的安全性和有效性。
