Karlinski Michal, Kobayashi Adam, Czlonkowska Anna, Mikulik Robert, Vaclavik Daniel, Brozman Miroslav, Gdovinova Zuzana, Švigelj Viktor, Csiba Laszlo, Fekete Klara, Kõrv Janika, Demarin Vida, Bašic-Kes Vanja, Vilionskis Aleksandras, Jatuzis Dalius, Krespi Yakup, Shamalov Nikolay, Andonova Silva, Ahmed Niaz, Wahlgren Nils
From the 2nd Department of Neurology (M.K., A.K., A.C.), and Interventional Stroke and Cerebrovascular Treatment Centre (A.K.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland (A.C.); International Clinical Research Center and Neurology Department, St Anne's Hospital in Brno and Masaryk University, Brno, Czech Republic (R.M.); Neurology Department, Ostava-Vítkovice Hospital, Research and Training Institute, Ostrava Czech Republic (D.V.); Neurology Department, University Hospital Nitra, Constantin Philosopher University, Nitra, Slovakia (M.B.); Department of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovakia (Z.G.); Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Slovenia (V.Š.); Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary (L.C., K.F.); Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.); Medical Center Aviva, Zagreb, Croatia (V.D.); Department of Neurology, University Hospital "Sestre Milosrdnice", Zagreb, Croatia (V.B.-K.); Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Lithuania (A.V.); Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University and Vilnius University Hospital Santariskiu Clinics, Lithuania (D.J.); Stroke Rehabilitation and Research Center, Memorial Sisli Hospital, Memorial Health Group Stroke Center, Istanbul, Turkey (Y.K.); Department of Neurology and Neurosurgery, Pirogov Russian National Medical University, Moscow, Russia (N.S.); Department of Neurological Diseases, Faculty of Medicine, Medical University of Varna, Bulgaria (S.A.); and Department of Neurology, Karolinska University Hospital, Solna and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A., N.W.).
From the 2nd Department of Neurology (M.K., A.K., A.C.), and Interventional Stroke and Cerebrovascular Treatment Centre (A.K.), Institute of Psychiatry and Neurology, Warsaw, Poland; Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland (A.C.); International Clinical Research Center and Neurology Department, St Anne's Hospital in Brno and Masaryk University, Brno, Czech Republic (R.M.); Neurology Department, Ostava-Vítkovice Hospital, Research and Training Institute, Ostrava Czech Republic (D.V.); Neurology Department, University Hospital Nitra, Constantin Philosopher University, Nitra, Slovakia (M.B.); Department of Neurology, Faculty of Medicine, Safarik University, Kosice, Slovakia (Z.G.); Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Slovenia (V.Š.); Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary (L.C., K.F.); Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.); Medical Center Aviva, Zagreb, Croatia (V.D.); Department of Neurology, University Hospital "Sestre Milosrdnice", Zagreb, Croatia (V.B.-K.); Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Lithuania (A.V.); Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University and Vilnius University Hospital Santariskiu Clinics, Lithuania (D.J.); Stroke Rehabilitation and Research Center, Memorial Sisli Hospital, Memorial Health Group Stroke Center, Istanbul, Turkey (Y.K.); Department of Neurology and Neurosurgery, Pirogov Russian National Medical University, Moscow, Russia (N.S.); Department of Neurological Diseases, Faculty of Medicine, Medical University of Varna, Bulgaria (S.A.); and Department of Neurology, Karolinska University Hospital, Solna and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A., N.W.). czlonkow
Stroke. 2015 Nov;46(11):3184-9. doi: 10.1161/STROKEAHA.115.010420. Epub 2015 Oct 8.
According to the European license, alteplase can be given no sooner than 3 months after previous stroke. However, it is not known whether past history of stroke influences the effect of treatment. Our aim was to evaluate safety and functional outcome after intravenous thrombolysis administered in everyday practice to patients with previous stroke≤3 months compared with those with first-ever stroke.
We analyzed consecutive cases treated with alteplase between October 2003 and July 2014 contributed to the Safe Implementation of Thrombolysis for Stroke-Eastern Europe registry from 12 countries. Odds ratios were calculated using unadjusted and adjusted logistic regression.
Of 13,007 patients, 11,221 (86%) had no history of stroke and 249 (2%) experienced previous stroke≤3 months before admission. Patients with previous stroke≤3 months had a higher proportion of hypertension and hyperlipidemia. There were no significant differences in outcome, including symptomatic intracerebral hemorrhage according to European Cooperative Acute Stroke Study (unadjusted odds ratio 1.27, 95% confidence interval: 0.74-2.15), and being alive and independent at 3 months (odds ratio 0.81, 95% confidence interval: 0.61-1.09).
Patients currently treated with alteplase, despite a history of previous stroke≤3 months, do not seem to achieve worse outcome than those with first-ever stroke. Although careful patient selection was probably of major importance, our findings provide reassurance that this group of patients may safely benefit from thrombolysis and should not be arbitrarily excluded as a whole. Further studies are needed to identify the shortest safe time lapse from the previous event to treatment with alteplase.
根据欧洲的许可规定，阿替普酶给药时间不得早于前次卒中后3个月。然而，尚不清楚既往卒中史是否会影响治疗效果。我们的目的是评估在日常临床实践中，对前次卒中发生时间≤3个月的患者与首次发生卒中的患者进行静脉溶栓治疗后的安全性和功能结局。
我们分析了2003年10月至2014年7月间，来自12个国家参与东欧卒中溶栓安全实施登记研究的连续使用阿替普酶治疗的病例。使用未校正和校正的逻辑回归计算比值比。
在13007例患者中，11221例（86%）无卒中史，249例（2%）在入院前3个月内有过卒中史。前次卒中发生时间≤3个月的患者高血压和高脂血症的比例更高。在结局方面，包括根据欧洲急性卒中协作研究定义的症状性脑出血（未校正比值比1.27，95%置信区间：0.74 - 2.15）以及3个月时存活且独立（比值比0.81，95%置信区间：0.61 - 1.09），均无显著差异。
目前接受阿替普酶治疗的患者，尽管有前次卒中发生时间≤3个月的病史，但结局似乎并不比首次发生卒中的患者差。虽然谨慎选择患者可能至关重要，但我们的研究结果表明，这类患者可安全地从溶栓治疗中获益，不应被一概排除。需要进一步研究来确定从前次事件到使用阿替普酶治疗的最短安全间隔时间。
