Anaissie James E, Monlezun Dominique J, Siegler James E, Waring Elizabeth D, Dowell Lauren N, Samai Alyana A, George Alexander J, Kimbrough Tara, Berthaud Jimmy, Martin-Schild Sheryl
Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana.
Stroke Program, Department of Neurology, Tulane University School of Medicine, New Orleans, Louisiana.
J Stroke Cerebrovasc Dis. 2016 Nov;25(11):2603-2609. doi: 10.1016/j.jstrokecerebrovasdis.2016.06.044. Epub 2016 Jul 28.
To evaluate the safety and efficacy of intravenous (IV) tissue plasminogen activator (tPA) in the treatment of wake-up stroke (WUS) using propensity score (PS) analysis.
Consecutive acute ischemic stroke patients meeting inclusion criteria were retrospectively identified from our stroke registry between July 2008 and May 2014, and classified as stroke onset less than or equal to 4.5 hours treated with tPA (control; n = 369), tPA-treated WUS (n = 46), or nontreated WUS (n = 154). The primary outcome of interest for safety was symptomatic intracerebral hemorrhage (sICH), defined as parenchymal hemorrhage associated with a greater than or equal to 4-point increase in National Institutes of Health Stroke Scale (NIHSS) score. Multivariate logistic regression with adjustment for confounders and PS for receiving IV tPA assessed outcomes, along with PS-matched average treatment effect on the treated (ATT).
No significant difference was found in rates of sICH between tPA-treated WUS, nontreated WUS, and controls (2.2%, .7%, and 3%, respectively), or in the odds of sICH between tPA-treated WUS and controls (OR = .53, 95% CI = .06-4.60, P = .568). Among WUS patients, tPA treatment was significantly associated with higher odds of good functional outcome in fully adjusted analyses (OR = 7.22, 95% CI = 2.28-22.88, P = .001). The ATT of tPA for WUS patients demonstrated a significantly greater decrease in NIHSS score at discharge when compared to nontreated WUS patients (-4.32 versus -.34, P = .032).
Comparable rates of sICH between treated WUS and stroke onset less than or equal to 4.5 hours treated with tPA suggest that tPA may be safely used to treat WUS. Superior outcomes for tPA-treated versus nontreated WUS subjects may suggest clinical efficacy of the treatment.
采用倾向评分（PS）分析评估静脉注射组织型纤溶酶原激活剂（tPA）治疗醒后卒中（WUS）的安全性和有效性。
回顾性纳入2008年7月至2014年5月期间符合纳入标准的急性缺血性卒中患者，分为卒中发作≤4.5小时接受tPA治疗的患者（对照组；n = 369）、接受tPA治疗的WUS患者（n = 46）或未接受治疗的WUS患者（n = 154）。安全性的主要观察指标为症状性颅内出血（sICH），定义为与美国国立卫生研究院卒中量表（NIHSS）评分增加≥4分相关的脑实质出血。采用多因素逻辑回归分析，对接受静脉tPA治疗的混杂因素和PS进行调整，评估结局，并分析PS匹配的治疗组平均治疗效果（ATT）。
接受tPA治疗的WUS患者、未接受治疗的WUS患者和对照组之间的sICH发生率无显著差异（分别为2.2%、0.7%和3%），接受tPA治疗的WUS患者和对照组之间的sICH几率也无显著差异（OR = 0.53，95%CI = 0.06 - 4.60，P = 0.568）。在WUS患者中，在完全调整分析中，tPA治疗与良好功能结局的较高几率显著相关（OR = 7.22，95%CI = 2.28 - 22.88，P = 0.001）。与未接受治疗WUS患者相比，WUS患者接受tPA治疗的ATT显示出院时NIHSS评分显著降低（-4.32对-0.34，P = 0.032）。
接受治疗的WUS患者与卒中发作≤4.5小时接受tPA治疗患者的sICH发生率相当，提示tPA可安全用于治疗WUS。接受tPA治疗的WUS患者与未接受治疗的患者相比结局更好，可能提示该治疗具有临床疗效。
