Thrombolysis Shows Potential After Wake-Up Stroke
(HealthDay News) – Selected patients with wake-up stroke (WUS) who receive thrombolysis have outcomes comparable to those treated with thrombolysis within 4.5 hours of stroke onset, according to a study presented at the American Heart Association's International Stroke Conference, held from February 1–3 in New Orleans.
Dulka Manawadu, MB, ChB, from King's College Hospital in London, and colleagues analyzed data from 68 WUS patients from 2009 and 2010 who received thrombolysis on compassionate grounds with consent, and compared their outcomes with 356 patients who received thrombolysis within 4.5 hours of stroke onset.
The investigators found that there were no significant differences in the mean National Institute of Health Stroke Scale score at 24 hours (9.2 for patients who received thrombolysis within 4.5 hours versus 8.1 for WUS patients; P=0.32). In addition, no significant differences were seen for any intracranial hemorrhage, symptomatic intracranial hemorrhage, or modified Rankin score 0 to 2 at three months. For WUS patients who received thrombolysis, mortality at three months was lower (15% vs. 24%; P=0.063), and after adjusting for covariates, this difference became significant (P=0.024).
"Functional and safety outcomes after thrombolysis in WUS patients selected using computed tomography imaging based protocols is comparable to that of patients treated within 4.5 hours of stroke onset. Our experience suggests that randomization of patients with WUS on the basis of defined imaging criteria in thrombolysis trials is appropriate," the authors write.