Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes with Alteplase at 0.6 mg/kg in Clinical Practice : THAWS2 Study
© 2023 S. Karger AG, Basel..
INTRODUCTION: The aim of this study was to determine the safety and efficacy of intravenous (IV) alteplase at 0.6 mg/kg for patients with acute wake-up or unclear-onset strokes in clinical practice.
METHODS: This multicenter observational study enrolled acute ischemic stroke patients with last-known-well time >4.5 h who had mismatch between DWI and FLAIR and were treated with IV alteplase. The safety outcomes were symptomatic intracranial hemorrhage (sICH) after thrombolysis, all-cause deaths, and all adverse events. The efficacy outcomes were favorable outcome defined as an mRS score of 0-1 or recovery to the same mRS score as the premorbid score, complete independence defined as an mRS score of 0-1 at 90 days, and change in NIHSS at 24 h from baseline.
RESULTS: Sixty-six patients (35 females; mean age, 74 ± 11 years; premorbid complete independence, 54 [82%]; median NIHSS on admission, 11) were enrolled at 15 hospitals. Two patients (3%) had sICH. Median NIHSS changed from 11 (IQR, 6.75-16.25) at baseline to 5 (3-12.25) at 24 h after alteplase initiation (change, -4.8 ± 8.1). At discharge, 31 patients (47%) had favorable outcome and 29 (44%) had complete independence. None died within 90 days. Twenty-three (35%) also underwent mechanical thrombectomy (no sICH, NIHSS change of -8.5 ± 7.3), of whom 11 (48%) were completely independent at discharge.
CONCLUSIONS: In real-world clinical practice, IV alteplase for unclear-onset stroke patients with DWI-FLAIR mismatch provided safe and efficacious outcomes comparable to those in previous trials. Additional mechanical thrombectomy was performed safely in them.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:53 |
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| Enthalten in: |
Cerebrovascular diseases (Basel, Switzerland) - 53(2024), 1 vom: 11., Seite 46-53 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Yoshimura, Sohei [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 14.02.2024 Date Revised 25.03.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1159/000530995 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM357653165 |
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| 100 | 1 | |a Yoshimura, Sohei |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes with Alteplase at 0.6 mg/kg in Clinical Practice |b THAWS2 Study |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 S. Karger AG, Basel. | ||
| 520 | |a INTRODUCTION: The aim of this study was to determine the safety and efficacy of intravenous (IV) alteplase at 0.6 mg/kg for patients with acute wake-up or unclear-onset strokes in clinical practice | ||
| 520 | |a METHODS: This multicenter observational study enrolled acute ischemic stroke patients with last-known-well time >4.5 h who had mismatch between DWI and FLAIR and were treated with IV alteplase. The safety outcomes were symptomatic intracranial hemorrhage (sICH) after thrombolysis, all-cause deaths, and all adverse events. The efficacy outcomes were favorable outcome defined as an mRS score of 0-1 or recovery to the same mRS score as the premorbid score, complete independence defined as an mRS score of 0-1 at 90 days, and change in NIHSS at 24 h from baseline | ||
| 520 | |a RESULTS: Sixty-six patients (35 females; mean age, 74 ± 11 years; premorbid complete independence, 54 [82%]; median NIHSS on admission, 11) were enrolled at 15 hospitals. Two patients (3%) had sICH. Median NIHSS changed from 11 (IQR, 6.75-16.25) at baseline to 5 (3-12.25) at 24 h after alteplase initiation (change, -4.8 ± 8.1). At discharge, 31 patients (47%) had favorable outcome and 29 (44%) had complete independence. None died within 90 days. Twenty-three (35%) also underwent mechanical thrombectomy (no sICH, NIHSS change of -8.5 ± 7.3), of whom 11 (48%) were completely independent at discharge | ||
| 520 | |a CONCLUSIONS: In real-world clinical practice, IV alteplase for unclear-onset stroke patients with DWI-FLAIR mismatch provided safe and efficacious outcomes comparable to those in previous trials. Additional mechanical thrombectomy was performed safely in them | ||
| 650 | 4 | |a Multicenter Study | |
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| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
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| 700 | 1 | |a Nagakane, Yoshinari |e verfasserin |4 aut | |
| 700 | 1 | |a Itabashi, Ryo |e verfasserin |4 aut | |
| 700 | 1 | |a Sakai, Nobuyuki |e verfasserin |4 aut | |
| 700 | 1 | |a Kimura, Kazumi |e verfasserin |4 aut | |
| 700 | 1 | |a Kamiyama, Kenji |e verfasserin |4 aut | |
| 700 | 1 | |a Shiokawa, Yoshiaki |e verfasserin |4 aut | |
| 700 | 1 | |a Yagita, Yoshiki |e verfasserin |4 aut | |
| 700 | 1 | |a Iwama, Toru |e verfasserin |4 aut | |
| 700 | 1 | |a Yakushiji, Yusuke |e verfasserin |4 aut | |
| 700 | 1 | |a Kusumi, Masayoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Yamaki, Tetsu |e verfasserin |4 aut | |
| 700 | 1 | |a Uemura, Jyunichi |e verfasserin |4 aut | |
| 700 | 1 | |a Yasuura, Asuka |e verfasserin |4 aut | |
| 700 | 1 | |a Noshiro, Shouhei |e verfasserin |4 aut | |
| 700 | 1 | |a Fukunaga, Daiki |e verfasserin |4 aut | |
| 700 | 1 | |a Yazawa, Yukako |e verfasserin |4 aut | |
| 700 | 1 | |a Aoki, Junya |e verfasserin |4 aut | |
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| 700 | 1 | |a Ihara, Masafumi |e verfasserin |4 aut | |
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