Readministration of intravenous alteplase in acute ischemic stroke patients: case series and systematic review
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 outc...
Saved in:
Published in | The American journal of emergency medicine Vol. 33; no. 2; pp. 307.e1 - 307.e4 |
---|---|
Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Elsevier Inc
01.02.2015
Elsevier Limited |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | 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. |
---|---|
Bibliography: | SourceType-Scholarly Journals-1 content type line 23 ObjectType-Feature-6 ObjectType-Review-2 ObjectType-Case Study-4 ObjectType-Undefined-1 ObjectType-Report-3 ObjectType-Article-5 |
ISSN: | 0735-6757 1532-8171 |
DOI: | 10.1016/j.ajem.2014.07.020 |