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| Mortality increased when ischaemic stroke treated with t-PA |
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14 June 2006
Treatment of acute ischaemic stroke with tissue-type plasminogen activator (t-PA) is associated with higher in-hospital mortality than is regular medical care, new research findings suggest. The significant differences between the groups remained after adjusting for comorbidities, age, and gender (odds ratio for death after thrombolysis, 1.9, p<0.0001).
Nevertheless, Dr Dubinsky would not recommend changes in practice, explaining that "t-PA is a medication that has significant potential to help people recover better from strokes." According to the neurologist, the reduction in risk from t-PA treatment over time "may be due to clinicians who are getting better at choosing which patients are most likely to benefit from thrombolysis."
The rate of secondary intracranial haemorrhage was also elevated at 4.2% in the t-PA group versus 0.4% in the control group (p<0.0001).
"The number of stroke patients in our retrospective analysis of an administrative data set is larger than other community cohort reports," the authors indicate, "and provides a realistic picture of the community use and mortality of thrombolysis for acute stroke in the United States."
In his interpretation of the findings, Dr Drubinsky noted, "It may be that neurologists will treat patients with severe strokes beyond what was allowed in clinical trials, the philosophy being that if the patient is going to be badly off anyway, let's try this heroic effort and see if it works."
The researcher was more surprised by the failure of most patients to receive thrombolytic therapy, which seemed to be related to the significant barrier of getting patients to the hospital within the 3-hour time window after symptom onset.
He concluded: "The promise of benefit from clinical trials is not always seen in community use of new treatments and therapeutics."
Reference:
Neurology 2006; 66: 1742-1744.
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