Effects of Ultraearly Intravenous Thrombolysis on Outcomes in Ischemic Stroke

T he effects of intravenous thrombolysis (IVT) in ischemic stroke are time dependent. Because of delays in conventional stroke workup, previous randomized IVT trials were unable to include patients with onset-to-treatment time (OTT) 60 minutes of symptom onset. With the invention of computed tomography-equipped mobile stroke units (MSUs), a relevant proportion of patients treated on such ambulances receive IVT within this ultraearly time window. In this study, we assessed the effects of IVT on 3-month functional outcome and mortality in different OTT intervals, including the first hour after onset, using a pooled analysis of 2 prospective prehospital and in-hospital registries in Berlin/Germany. ethods of patient inclusion and documentation in the 2 registries were described elsewhere 4 (URL: http://www.clinicaltrials.gov. Unique identifier: NCT02358772). Briefly, all patients admitted through emergency medical services who received IVT between February 5, 2011, and March 5, 2015, were included in the registries. The prehospital registry included patients thrombolysed in an MSU and admitted to the nearest stroke unit thereafter. Intra-arterial treatment was optional in patients with occlusion of proximal intracranial arteries in both cohorts. The in-hospital registry comprised patients receiving IVT at Charit-Universittsmedizin, Campus Benjamin Franklin. We excluded patients with nonstroke diagnosis, IVT without known exact (witnessed) time of onset, denial/withdrawal of informed consent for follow-up, missing 3-month follow-up, or incomplete documentation of data used in the multivariable analyses.