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Tsivgoulis G, Katsanos AH, Kadlecová P, Czlonkowska A, Kobayashi A, Brozman M, Švigelj V, Csiba L, Fekete K, Kõrv J, Demarin V, Vilionskis A, Jatuzis D, Krespi Y, Karapanayiotides T, Giannopoulos S, Mikulik R. Intravenous thrombolysis for patients with in-hospital stroke onset: propensity-matched analysis from the Safe Implementation of Treatments in Stroke-East registry. Eur J Neurol 2017; 24:1493-1498. [PMID: 28888075 DOI: 10.1111/ene.13450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Recent cross-sectional study data suggest that intravenous thrombolysis (IVT) in patients with in-hospital stroke (IHS) onset is associated with unfavorable functional outcomes at hospital discharge and in-hospital mortality compared to patients with out-of-hospital stroke (OHS) onset treated with IVT. We sought to compare outcomes between IVT-treated patients with IHS and OHS by analysing propensity-score-matched data from the Safe Implementation of Treatments in Stroke-East registry. METHODS We compared the following outcomes for all propensity-score-matched patients: (i) symptomatic intracranial hemorrhage defined with the safe implementation of thrombolysis in stroke-monitoring study criteria, (ii) favorable functional outcome defined as a modified Rankin Scale (mRS) score of 0-1 at 3 months, (iii) functional independence defined as an mRS score of 0-2 at 3 months and (iv) 3-month mortality. RESULTS Out of a total of 19 077 IVT-treated patients with acute ischaemic stroke, 196 patients with IHS were matched to 5124 patients with OHS, with no differences in all baseline characteristics (P > 0.1). Patients with IHS had longer door-to-needle [90 (interquartile range, IQR, 60-140) vs. 65 (IQR, 47-95) min, P < 0.001] and door-to-imaging [40 (IQR, 20-90) vs. 24 (IQR, 15-35) min, P < 0.001] times compared with patients with OHS. No differences were detected in the rates of symptomatic intracranial hemorrhage (1.6% vs. 1.9%, P = 0.756), favorable functional outcome (46.4% vs. 42.3%, P = 0.257), functional independence (60.7% vs. 60.0%, P = 0.447) and mortality (14.3% vs. 15.1%, P = 0.764). The distribution of 3-month mRS scores was similar in the two groups (P = 0.273). CONCLUSIONS Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS.
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Affiliation(s)
- G Tsivgoulis
- Second Department of Neurology, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,International Clinical Research Center and Neurology Department, St Anne's Hospital, Brno, Czech Republic
| | - A H Katsanos
- Second Department of Neurology, 'Attikon' Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Ioannina, Ioannina, Greece
| | - P Kadlecová
- International Clinical Research Center and Neurology Department, St Anne's Hospital, Brno, Czech Republic
| | - A Czlonkowska
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw.,Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw
| | - A Kobayashi
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw.,Department of Neuroradiology, Interventional Stroke and Cerebrovascular Disease Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M Brozman
- Department of Neurology, Faculty Hospital Nitra, Constantine University Nitra, Nitra, Slovakia
| | - V Švigelj
- Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - L Csiba
- Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - K Fekete
- Department of Neurology, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - J Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - V Demarin
- Department of Neurology, Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | - A Vilionskis
- Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Vilnius
| | - D Jatuzis
- Department of Neurology and Neurosurgery, Center for Neurology, Vilnius University, Vilnius, Lithuania
| | - Y Krespi
- Neurology Department and Stroke Center, Memorial Sisli Hospital Istanbul, Istanbul, Turkey
| | - T Karapanayiotides
- Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - S Giannopoulos
- Department of Neurology, University of Ioannina, Ioannina, Greece
| | - R Mikulik
- International Clinical Research Center and Neurology Department, St Anne's Hospital, Brno, Czech Republic.,Medical Faculty of Masaryk University, Brno, Czech Republic
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Kõrv J, Vibo R, Kadlecová P, Kobayashi A, Czlonkowska A, Brozman M, Švigelj V, Csiba L, Fekete K, Demarin V, Vilionskis A, Jatuzis D, Krespi Y, Ahmed N, Mikulík R. Benefit of thrombolysis for stroke is maintained around the clock: results from the SITS-EAST Registry. Eur J Neurol 2013; 21:112-7. [DOI: 10.1111/ene.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 07/26/2013] [Indexed: 11/28/2022]
Affiliation(s)
- J. Kõrv
- Department of Neurology and Neurosurgery; University of Tartu; Tartu Estonia
| | - R. Vibo
- Department of Neurology and Neurosurgery; University of Tartu; Tartu Estonia
| | - P. Kadlecová
- International Clinical Research Center; St Anne's Hospital; Brno Czech Republic
| | - A. Kobayashi
- Second Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
- Interventional Stroke Treatment Centre; Institute of Psychiatry and Neurology; Warsaw Poland
| | - A. Czlonkowska
- Second Department of Neurology; Institute of Psychiatry and Neurology; Warsaw Poland
- Department of Experimental and Clinical Pharmacology; Medical University of Warsaw; Warsaw Poland
| | - M. Brozman
- Neurology Department; University Hospital Nitra; Nitra Slovakia
| | - V. Švigelj
- Department of Vascular Neurology and Neurological Intensive Care; University Medical Centre Ljubljana and Zdravstveni Nasveti; Ljubljana Slovenia
| | - L. Csiba
- Department of Neurology; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
| | - K. Fekete
- Department of Neurology; Medical and Health Science Center; University of Debrecen; Debrecen Hungary
| | | | - A. Vilionskis
- Department of Neurology and Neurosurgery; Vilnius University and Republican Vilnius University Hospital; Vilnius Lithuania
| | - D. Jatuzis
- Department of Neurology and Neurosurgery; Vilnius University and Vilnius University Hospital Santariskiu Clinics; Vilnius Lithuania Lithuania
| | - Y. Krespi
- Stroke Rehabilitation and Research Center; Memorial Sisli Hospital; Memorial Health Group Stroke Center; Istanbul Turkey
| | - N. Ahmed
- Department of Neurology; Karolinska University Hospital; Solna, and Department of Clinical Neuroscience; Karolinska Institutet; Stockholm Sweden
| | - R. Mikulík
- Neurology Department; International Clinical Research Center; St Anne's Hospital; Brno Czech Republic
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