Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill 27514-3526, USA.
J Stroke Cerebrovasc Dis. 2012 Oct;21(7):541-6. doi: 10.1016/j.jstrokecerebrovasdis.2010.12.004. Epub 2011 Jan 14.
Tissue plasminogen activator therapy (t-PA) is associated with improved neurologic outcomes and reduced disability from ischemic stroke. The current guidelines stipulate that patients receive t-PA within 3 hours of symptom onset. However, actual practice patterns vary, and little is known about patient outcomes when t-PA is received outside of the recommended time window.
We examined mean length of hospital stay, t-PA-related complications, and in-hospital death by time of t-PA administration in North Carolina Stroke Care Collaborative (NCSCC) patients. The NCSCC includes 53 hospitals that enroll patients presenting with stroke-like symptoms. Of 40,907 patients enrolled between January 2005 and February 2010, 1070 (2.6%) received t-PA. Of these, 88.2% received t-PA within 3 hours of symptom onset ("early") and 30.3% received t-PA between 3 and 6 hours after symptom onset ("late").
Unadjusted mean length of stay (days) was longer among early patients (5.0 days; 95% confidence interval [CI], 4.7-5.3) than late patients (3.6 days; 95% CI, 3.1-4.2). t-PA-related complications were similar among early (7.0%; 55/781) and late patients (6.7%; 7/102; P = .89). The proportion of in-hospital deaths was similar among late (10.5%) and early patients (12.0%). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% CIs for the associations between late t-PA status and patient outcomes.
In models controlling for age, race, sex, arrival mode, and ambulatory status on admission, late t-PA was not associated with increased odds of complications or in-hospital deaths (OR, 0.89; 95% CI, 0.49-1.62). The risks and benefits of expansion of the t-PA time window in stroke patients merit further investigation.
组织型纤溶酶原激活剂治疗（t-PA）可改善缺血性脑卒中患者的神经功能预后并降低残疾程度。目前的指南规定，患者应在症状发作后 3 小时内接受 t-PA 治疗。然而，实际的治疗模式存在差异，对于 t-PA 治疗时间超出推荐时间窗的患者，其预后情况知之甚少。
我们在北卡罗来纳州卒中护理协作组（NCSCC）患者中，根据 t-PA 给药时间，分析了平均住院时间、t-PA 相关并发症和住院期间死亡率。NCSCC 包括 53 家收治具有卒中样症状患者的医院。2005 年 1 月至 2010 年 2 月间共纳入 40907 例患者，其中 1070 例（2.6%）接受了 t-PA 治疗。其中，88.2%的患者在症状发作后 3 小时内接受 t-PA 治疗（“早期”），30.3%的患者在症状发作后 3 至 6 小时内接受 t-PA 治疗（“晚期”）。
未经调整的早期患者（5.0 天；95%置信区间 [CI]，4.7-5.3）的平均住院时间（天）长于晚期患者（3.6 天；95%CI，3.1-4.2）。早期患者（7.0%；55/781）与晚期患者（6.7%；7/102；P =.89）的 t-PA 相关并发症发生率相似。晚期患者（10.5%）与早期患者（12.0%）的住院期间死亡率相似。我们采用多变量逻辑回归估计晚期 t-PA 状态与患者预后之间的比值比（OR）及其 95%CI。
在控制年龄、种族、性别、入院方式和入院时活动能力的模型中，晚期 t-PA 与并发症或住院期间死亡率增加无关（OR，0.89；95%CI，0.49-1.62）。进一步扩大 t-PA 在卒中患者中的时间窗的风险和获益值得进一步研究。
