Effects of Prehospital Thrombolysis in Stroke Patients With Prestroke Dependency

BACKGROUND AND PURPOSE—Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily –independent patients suggest that earlier start of...

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Published in:Stroke (1970) 2018-03, Vol.49 (3), p.646-651
Main Authors: Nolte, Christian H, Ebinger, Martin, Scheitz, Jan F, Kunz, Alexander, Erdur, Hebun, Geisler, Frederik, Braemswig, Tim-Bastian, Rozanski, Michal, Weber, Joachim E, Wendt, Matthias, Zieschang, Katja, Fiebach, Jochen B, Villringer, Kersten, Grittner, Ulrike, Kaczmarek, Sabina, Endres, Matthias, Audebert, Heinrich J
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Female
Hospitalization
Humans
Intracranial Hemorrhages - diagnosis
Intracranial Hemorrhages - drug therapy
Intracranial Hemorrhages - mortality
Male
Registries
Retrospective Studies
Stroke - diagnosis
Stroke - drug therapy
Stroke - mortality
Thrombolytic Therapy
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Summary:BACKGROUND AND PURPOSE—Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily –independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency. METHODS—This observational, retrospective analysis included all patients with acute ischemic stroke depending on assistance before stroke who received intravenous thrombolysis either on the Stroke Emergency Mobile (STEMO) or through conventional in-hospital care (CC) in a tertiary stroke center (Charité, Campus Benjamin Franklin, Berlin) during routine care. Prespecified outcomes were modified Rankin Scale scores of 0 to 3 and survival at 3 months, as well as symptomatic intracranial hemorrhage. Outcomes were adjusted in multivariable logistic regression. RESULTS—Between February 2011 and March 2015, 122 of 427 patients (28%) treated on STEMO and 142 of 505 patients (28%) treated via CC needed assistance before stroke. Median onset-to-treatment times were 97 (interquartile range, 69–159; STEMO) and 135 (interquartile range, 98–184; CC; P
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.117.019060