Key result
Recent TIA within 24 hours of stroke is linked to increased post-thrombolysis symptomatic intracerebral hemorrhage.
Why the study?
The safety and efficacy of intravenous thrombolysis with rt-PA in patients with acute ischemic stroke following a recent transient ischemic attack within 24 hours is an important clinical problem.
Does a TIA within 24 hours prior to acute ischemic stroke increase the risk of adverse outcomes or bleeding in patients treated with intravenous thrombolysis?
Cohort (n=400)
Yes
Does a TIA within 24 hours prior to acute ischemic stroke increase the risk of adverse outcomes or bleeding in patients treated with intravenous thrombolysis?
p-value: p=0.01
A transient ischemic attack within 24 hours prior to an acute ischemic stroke is associated with an increased risk of symptomatic intracerebral hemorrhage following intravenous thrombolysis.
Recent TIA within 24 h was associated with higher SICH risk after iv-thrombolysis; leaves open whether eligibility criteria should change.
BACKGROUND: Intravenous thrombolysis (iv-thrombolysis) with the use of rt-PA in patients after recent transient ischemic attack (TIA) is an important clinical problem. The aim of the study was to assess the impact of TIA within 24h preceding acute ischemic stroke (AIS) on the safety and efficacy of iv-thrombolysis. METHODS: We retrospectively evaluated the clinical and demographic data of 400 patients with AIS who were consecutively treated with iv-thrombolysis from September 2006 to May 2011 in three stroke centers. RESULTS: At three-month follow-up, 58.0% of patients were independent (modified Rankin scale; mRS 0-2), 17.8% had died, 17.0% suffered hemorrhagic transformation (HT) and 4.3% experienced symptomatic intracerebral hemorrhage (SICH). There were 29 patients (7.3%) who had a previous ipsilateral TIA within 24h before established stroke. In the TIA subgroup, there was no significant higher percentage of favorable outcome (p=0.07) and higher SICH rate (p=0.15). Multivariate analysis showed the impact of prior TIA within 24h before stroke onset in the presence of SICH (p=0.01), no impact of TIA on unfavorable outcomes after three months (p=0.25) and on the mortality rate within three months (p=0.41). CONCLUSION: TIA within 24h prior to ischemic stroke can portend severe intracerebral bleeding in patients qualified to iv-thrombolysis with the use of rt-PA.
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Sobolewski et al. (2014) conducted a cohort in Acute ischemic stroke (n=400). Transient ischemic attack (TIA) within 24h preceding acute ischemic stroke vs. No TIA within 24h preceding acute ischemic stroke was evaluated on Symptomatic intracerebral hemorrhage (SICH) (p=0.01). A transient ischemic attack within 24 hours prior to acute ischemic stroke was significantly associated with symptomatic intracerebral hemorrhage after intravenous thrombolysis (P=0.01).
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