Søyland Mary-Helen, Tveiten Arnstein, Eltoft Agnethe, Øygarden Halvor, Varmdal Torunn, Indredavik Bent, Mathiesen Ellisiv B
Department of Neurology Hospital of Southern Norway Kristiansand Norway.
Department of Clinical Medicine UiT The Arctic University of Norway Tromsø Norway.
J Am Heart Assoc. 2024 Feb 6;13(3):e032309. doi: 10.1161/JAHA.123.032309. Epub 2024 Jan 31.
Previous clinical trials found improved outcome of thrombolytic treatment in patients with ischemic wake-up stroke (WUS) selected by advanced imaging techniques. The authors assessed the effectiveness of thrombolytic treatment in patients with WUS in a nationwide stroke registry.
Using propensity score matching, the authors assessed the effectiveness and safety of thrombolytic treatment versus no thrombolytic treatment in 726 patients (363 matched pairs) with WUS in the Norwegian Stroke Registry in 2014 to 2019. Thrombolytic treatment in WUS versus known-onset stroke was compared in 730 patients (365 matched pairs). Functional outcomes were assessed by the modified Rankin Scale (mRS) at 3 months. A significant benefit of thrombolytic treatment in WUS was seen in ordinal analysis (odds ratio [OR], 1.48 [95% CI, 1.15-1.91]; =0.003) and for mRS 0 to 2 (OR, 1.81 [95% CI, 1.29-2.52]; =0.001) but not for mRS 0 or 1 (OR, 1.32 [95% CI, 1.00-1.74]; =0.050). The proportion of patients with mRS 0 or 1 was lower in patients with WUS who underwent thrombolysis versus those with known-onset stroke (50.4% versus 59.5%; OR, 0.69 [95% CI, 0.52-0.93]; =0.013), while outcomes were similar between groups for mRS 0 to 2 and ordinal analysis. Symptomatic intracranial hemorrhage after thrombolytic treatment occurred in 4.4% of patients with WUS and 3.9% of patients with known-onset stroke (OR, 1.14 [95% CI, 0.54-2.41]; =0.726).
Thrombolytic treatment in patients with WUS was associated with improved functional outcome compared with patients with no thrombolytic treatment and was not associated with increased rates of symptomatic intracranial hemorrhage compared with known-onset stroke. The results indicate that thrombolytic treatment is effective and safe in WUS in a real-life setting.
先前的临床试验发现，采用先进成像技术筛选出的缺血性醒后卒中（WUS）患者，溶栓治疗的预后得到改善。作者在一项全国性卒中登记研究中评估了WUS患者溶栓治疗的有效性。
作者采用倾向评分匹配法，在2014年至2019年的挪威卒中登记研究中，评估了726例（363对匹配病例）WUS患者接受溶栓治疗与未接受溶栓治疗的有效性和安全性。对730例（365对匹配病例）患者比较了WUS与已知发病时间卒中的溶栓治疗情况。在3个月时采用改良Rankin量表（mRS）评估功能结局。在序贯分析中（优势比[OR]，1.48[95%CI，1.15 - 1.91]；P = 0.003）以及mRS评分为0至2时（OR，1.81[95%CI，1.29 - 2.52]；P = 0.001），可见WUS患者溶栓治疗有显著益处，但mRS评分为0或1时无显著益处（OR，1.32[95%CI，1.00 - 1.74]；P = 0.050）。接受溶栓治疗的WUS患者中mRS评分为0或1的比例低于已知发病时间卒中患者（50.4%对59.5%；OR，0.69[95%CI，0.52 - 0.93]；P = 0.013），而两组间mRS评分为0至2及序贯分析的结局相似。WUS患者溶栓治疗后症状性颅内出血发生率为4.4%，已知发病时间卒中患者为3.9%（OR，1.14[95%CI，0.54 - 2.41]；P = 0.726）。
与未接受溶栓治疗的患者相比，WUS患者接受溶栓治疗与功能结局改善相关，与已知发病时间卒中相比，症状性颅内出血发生率未增加。结果表明，在现实环境中，WUS患者溶栓治疗有效且安全。
