Key result
IV alteplase shows comparable 3-month functional outcomes to standard thrombolysis in wake-up stroke.
Why the study?
Wake-up stroke accounts for up to a quarter of all ischemic strokes, creating a need to establish the safety and efficacy of intravenous thrombolytic treatment compared with standard thrombolysis for clear-onset strokes and untreated wake-up strokes.
Observational (n=95)
Open-label
No
Answers are grounded in this paper and cite their sources.
May support alteplase consideration in wake-up stroke; leaves open confirmation by randomized trials before practice change.
OBJECTIVES: Wake-up stroke is an important clinical problem that may account for a quarter of all ischemic strokes. This study aimed to establish the safety and efficacy of intravenous thrombolytic treatment of wake-up strokes by comparing it to the standard thrombolysis treatment in strokes with clear onsets and wake-up strokes that did not receive reperfusion therapy. METHODS: This retrospective study enrolled 95 patients with ischemic strokes who underwent thrombolytic treatment with alteplase, including nine patients with wake-up strokes. The safety profile (mortality and intracranial bleeding) and efficacy (clinical and functional outcomes on admission, discharge, and 90 days after stroke onset) were evaluated. RESULTS: When assessed using the modified Rankin scale (mRs), the patients with wake-up strokes had significantly more favorable functional outcomes on discharge when compared to those who received standard thrombolysis (p = .0289). No significant differences were noted when the favorable outcome rate (mRs score = 0-2) at three months post-thrombolysis (Odds ratio [OR] = 2.07; 95% confidence interval [CI] = 0.41-10.6; p = .3807) and safety outcomes (death during hospitalization: OR = 0.49; 95% CI = 0.03-9.11; p = .6295 and intracranial bleeding 24 hr after treatment: OR = 0.43; 95% CI = 0.02-7.58; p = .5707) were compared between the two groups. The Cochran-Mantel-Haenchel shift analysis showed a significantly more favorable distribution of the mRs scores at three months after the stroke onset in the patients with wake-up strokes who were treated with alteplase compared to those who did not receive thrombolysis (OR = 1.42; 95% CI = 1.01-1.82; p = .0426). CONCLUSIONS: Our study demonstrated that in patients who awaken with stroke symptoms, intravenous thrombolytic treatment is a safe procedure that may lead to favorable outcomes. Further studies should be performed to increase the size of the group of patients with wake-up strokes who can be treated with reperfusion therapy.
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Adam Wiśniewski (2021) conducted an observational in Wake-up ischemic stroke (n=95). Intravenous alteplase thrombolysis in wake-up stroke protocol vs. Standard intravenous thrombolysis in clear-onset stroke (and untreated wake-up stroke) was evaluated on Favorable functional outcome (modified Rankin Scale score 0-2) at 3 months post-thrombolysis (OR 2.07, 95% CI 0.41-10.6, p=0.3807). Intravenous alteplase in wake-up stroke showed comparable 3-month favorable outcomes (mRS 0-2) to standard thrombolysis (77.7% vs 62.8%; OR 2.07, 95% CI 0.41-10.6, p=0.3807) with no bleeding increase.
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