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| Most clots dissolve within 1 hour of thrombolysis |
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07 March 2006
The majority of thrombolysis-induced recanalisations occur within the first hour after tissue plasminogen activator (t-PA) administration, say Spanish researchers, who recommend the use of alternative methods of clot removal after this time period.
Dr Marc Ribo and colleagues from the Unitat Neurovascular Hospital Vall d'Hebron in Barcelona used continuous transcranial Doppler to assess recanalisation in 179 acute stroke patients who were treated with t-PA. They note that the "continuous insonation of the offending thrombus" may have resulted in higher rates of recanalisation than would have occurred without the use of transcranial Doppler.
Writing in the journal Stroke, the team reports that the majority of recanalisations occurred during the first hour after administration of t-PA, when 43% of patients achieved complete or partial recanalisation. By the end of the second hour after treatment, complete or partial recanalisation was observed in a further 11% of patients, and another 7% achieved recanalisation before the cessation of monitoring at 6 hours after treatment.
"These data encourage the adoption of rescue reperfusion approaches in those cases in which complete recanalisation is not observed 1 hour after t-PA bolus," the researchers suggest.
Importantly, patients who had not exhibited recanalisation until more than 2 hours after treatment had similar National Institutes of Health Stroke Scale scores at 48 hours to those who had achieved faster recanalisation, at 3 versus 4.5 points, respectively. In addition, the number of patients achieving a favourable 3-month outcome, with modified Rankin Scale scores of 2 or lower, was not influenced by the speed of recanalisation. The investigators stress that this finding supports the initiation of thrombolysis beyond the customary limit of 3 hours after stroke onset.
Reference:
Stroke 2006; 37 (4): 1000-1004.
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