Readministration of intravenous alteplase in acute ischemic stroke patients: case series and systematic review

• Published in: The American journal of emergency medicine Vol. 33; no. 2; pp. 307.e1 - 307.e4
• Main Authors: Qureshi, Adnan I., MD, Malik, Ahmed A., MD, Freese, Melissa, RN, Thompson, Michelle J., CAGNP, Khan, Asif A., MD, Suri, M. Fareed K., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2015; Elsevier Limited
• Subjects: Administration, Intravenous; Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Cardiac arrhythmia; Cardiovascular disease; Computed tomography; Coronary vessels; Diabetes; Drug therapy; Emergency; Emergency medical care; Female; Fibrinolytic Agents - administration & dosage; Fibrinolytic Agents - therapeutic use; Humans; Hypertension; Male; Middle Aged; Patients; Recurrence; Stroke; Stroke - drug therapy; Time Factors; Tissue Plasminogen Activator - administration & dosage; Tissue Plasminogen Activator - therapeutic use
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2014.07.020

Because of a high risk of recurrence of ischemic events, some patients may be candidates for readministration of intravenous (IV) alteplase. We performed a single-center review and performed a search on PubMed from January 1966 to April 2014 for cases of readministration of alteplase. Favorable outcome was defined by a modified Rankin scale of 0 to 2 at discharge or at 1 to 3 months, improvement of greater than or equal to 4 points within 24 hours in the National Institutes of Health Stroke Scale score, or as a major improvement in the 72-hour National Institutes of Health Stroke Scale score. Four ischemic stroke patients underwent readministration of IV alteplase in our single-center review. None of the patients had symptomatic or asymptomatic intracerebral hemorrhage.In 2 patients, IV alteplase had been administered for a previous acute ischemic stroke, 6 and 49 days before the index ischemic stroke.At discharge, both patients had a favorable outcome. A total of 22 cases of readministration of alteplase for ischemic stroke have been reported in literature. The mean interval between the 2 administrations of alteplase was 428 days (range, 3 hours to 2280 days).Asymptomatic post thrombolytic intracerebral hemorrhages were seen in 2 patients. Favorable outcome was seen in 16 patients. A total of 9 underwent readministration of IV alteplase within 3 months for recurrent ischemic stroke. Favorable outcome was seen in 5 of these 9 patients. We observed a relatively high rate of favorable outcomes and a small rate of adverse events after readministration of IV alteplase in ischemic stroke patients.