Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida.
Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
JAMA Neurol. 2015 Apr;72(4):423-31. doi: 10.1001/jamaneurol.2014.4354.
Mild strokes have been poorly represented in thrombolytic trials and only a few series have reported outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) after mild stroke.
To report treatment complications and short-term outcomes in patients with mild stroke who have received treatment with IV rtPA.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of patients treated in the emergency department of hospitals that use the Get With the Guidelines-Stroke registry, a prospectively collected quality improvement registry used by hospitals across the United States. Patients were those admitted between May 1, 2010, and October 1, 2012, with acute ischemic stroke within 4.5 hours from symptom onset and a baseline National Institutes of Health Stroke Scale score of 5 or less. Univariable and multivariable analyses were performed to identify factors independently associated with discharge outcomes and treatment complications.
Intravenous rtPA.
Treatment complications included symptomatic intracranial hemorrhage, life-threatening or serious systemic hemorrhage, other serious complications, and undetermined complications. The short-term outcomes analyzed were in-hospital mortality, discharge to home, independent ambulation at discharge, and length of stay.
Among 33,995 patients who arrived within 4.5 hours of symptom onset and were treated with IV rtPA, 7621 (22.4%) had a National Institutes of Health Stroke Scale score of 5 or less and 5910 had complete data for analysis. Treatment complications were infrequent: symptomatic intracranial hemorrhage, 1.8%; life-threatening or serious systemic hemorrhage, 0.2%; other serious complications, 1.8%; and complications of undetermined cause, 2.4%. Mortality was low (1.3%), but at discharge 30.3% could not ambulate independently, 29.4% could not go directly home, and 73.0% had a length of stay of 3 days or longer. Worse short-term outcomes were seen in older patients, African American patients, diabetic patients, and those who arrived by ambulance, after hours, or with a higher National Institutes of Health Stroke Scale score.
Many patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.
溶栓试验中轻度中风的代表性较差，只有少数系列报道了轻度中风后接受静脉（IV）重组组织纤溶酶原激活剂（rtPA）治疗的结果。
报告接受 IV rtPA 治疗的轻度中风患者的治疗并发症和短期结局。
设计、地点和参与者：对在美国各地医院使用 Get With the Guidelines-Stroke 登记处的急诊科治疗的患者进行回顾性分析，这是一个前瞻性收集的质量改进登记处。患者为 2010 年 5 月 1 日至 2012 年 10 月 1 日期间发病，症状出现后 4.5 小时内发生急性缺血性中风，基线国立卫生研究院中风量表（NIHSS）评分为 5 或更低。进行单变量和多变量分析以确定与出院结局和治疗并发症独立相关的因素。
静脉 rtPA。
治疗并发症包括症状性颅内出血、危及生命或严重全身性出血、其他严重并发症和原因不明的并发症。分析的短期结果包括院内死亡率、出院回家、出院时独立行走和住院时间。
在发病后 4.5 小时内接受 IV rtPA 治疗且 NIHSS 评分为 5 或更低的 33995 例患者中，7621 例（22.4%）存在 NIHSS 评分为 5 或更低，5910 例有完整的数据进行分析。治疗并发症并不常见：症状性颅内出血，1.8%；危及生命或严重全身性出血，0.2%；其他严重并发症，1.8%；原因不明的并发症，2.4%。死亡率较低（1.3%），但出院时 30.3%的患者不能独立行走，29.4%的患者不能直接回家，73.0%的患者住院时间为 3 天或更长。年龄较大的患者、非裔美国患者、糖尿病患者以及乘坐救护车、下班后或 NIHSS 评分较高到达的患者预后较差。
接受 IV rtPA 治疗的缺血性中风患者中有许多患有轻度中风。症状性颅内出血并不常见，但这些患者中约有 30%在出院时无法直接回家或独立行走。需要进一步研究以确定改善接受溶栓治疗的轻度中风患者结局的策略。
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