Poor Outcomes in Patients Who Do Not Receive Intravenous Tissue Plasminogen Activator Because of Mild or Improving Ischemic Stroke

DOI Web Site 被引用文献7件
  • Eric E. Smith
    From the Department of Neurology (E.E.S., A.R.A., W.J.K., L.H.S.), Massachusetts General Hospital, Boston; the Department of Radiological Sciences (I.P.), UCLA, Los Angeles, Calif; and the Department of Internal Medicine (E.R.), Beth Israel-Deaconess Medical Center, Boston, Mass.
  • Abdul R. Abdullah
    From the Department of Neurology (E.E.S., A.R.A., W.J.K., L.H.S.), Massachusetts General Hospital, Boston; the Department of Radiological Sciences (I.P.), UCLA, Los Angeles, Calif; and the Department of Internal Medicine (E.R.), Beth Israel-Deaconess Medical Center, Boston, Mass.
  • Iva Petkovska
    From the Department of Neurology (E.E.S., A.R.A., W.J.K., L.H.S.), Massachusetts General Hospital, Boston; the Department of Radiological Sciences (I.P.), UCLA, Los Angeles, Calif; and the Department of Internal Medicine (E.R.), Beth Israel-Deaconess Medical Center, Boston, Mass.
  • Eric Rosenthal
    From the Department of Neurology (E.E.S., A.R.A., W.J.K., L.H.S.), Massachusetts General Hospital, Boston; the Department of Radiological Sciences (I.P.), UCLA, Los Angeles, Calif; and the Department of Internal Medicine (E.R.), Beth Israel-Deaconess Medical Center, Boston, Mass.
  • Walter J. Koroshetz
    From the Department of Neurology (E.E.S., A.R.A., W.J.K., L.H.S.), Massachusetts General Hospital, Boston; the Department of Radiological Sciences (I.P.), UCLA, Los Angeles, Calif; and the Department of Internal Medicine (E.R.), Beth Israel-Deaconess Medical Center, Boston, Mass.
  • Lee H. Schwamm
    From the Department of Neurology (E.E.S., A.R.A., W.J.K., L.H.S.), Massachusetts General Hospital, Boston; the Department of Radiological Sciences (I.P.), UCLA, Los Angeles, Calif; and the Department of Internal Medicine (E.R.), Beth Israel-Deaconess Medical Center, Boston, Mass.

抄録

<jats:p> <jats:bold> <jats:italic>Background and Purpose—</jats:italic> </jats:bold> Some patients with mild or improving ischemic stroke symptoms do not receive intravenous tissue plasminogen activator (tPA) because they look “too good to treat” (TGT); however, some have poor outcomes. </jats:p> <jats:p> <jats:bold> <jats:italic>Methods—</jats:italic> </jats:bold> We retrospectively analyzed data from a prospective single-center study between 2002 and 2004. TGT patients were those arriving within 3 hours of symptom onset and not treated with intravenous tPA solely because of mild or improving symptoms. </jats:p> <jats:p> <jats:bold> <jats:italic>Results—</jats:italic> </jats:bold> Of 128 patients presenting within 3 hours, 41 (34%) were not given tPA because of mild or improving stroke. Of the TGT patients, 11 of 41 (27%) died or were not discharged home because of neurological worsening (n=6) or persistent “mild” neurological deficit (n=5). No single variable at presentation was associated with death or lack of home discharge. There were 10 of 41 TGT patients (24%) who had ≥4-point improvement in National Institutes of Health Stroke Scale score before tPA decision; these patients were more likely to have subsequent neurological worsening (relative risk, 4.1, 95% CI, 1.1 to 15.4; <jats:italic>P</jats:italic> =0.05). </jats:p> <jats:p> <jats:bold> <jats:italic>Conclusion—</jats:italic> </jats:bold> A substantial minority of patients deemed too good for intravenous tPA were unable to be discharged home. A re-evaluation of the stroke severity criteria for tPA eligibility may be indicated. </jats:p>

収録刊行物

  • Stroke

    Stroke 36 (11), 2497-2499, 2005-11

    Ovid Technologies (Wolters Kluwer Health)

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