Reasons for non-thrombolysis comparing the first with the second half of the observation period
| Year | ||||||
|---|---|---|---|---|---|---|
| Patients (n=2019) | 2003–2006 (n=959) | 2007–2011 (n=1060) | OR | 95% CI | ||
| Patient characteristics | ||||||
| Age (median quartiles) | 73 | 60, 81 | 74 | 61, 83 | 1.00 | 0.99 to 1.00 |
| Sex (male) | 530 | 55.3% | 601 | 56.7% | 0.94 | 0.79 to 1.13 |
| Admission NIHSS (median quartiles) | 5 | 3, 12 | 4 | 2, 9 | 1.00* | 1.00 to 1.01 |
| Stroke mechanism (TOAST)† | ||||||
| Atherosclerosis with ≥50% (NASCET) stenosis | 106 | 11.1% | 147 | 13.9% | 0.73* | 0.56 to 0.95 |
| Likely atherosclerosis/aortic, without significant stenosis‡ | 151 | 15.7% | 152 | 14.3% | 1.06 | 0.83 to 1.35 |
| Cardioembolism | 277 | 28.9% | 301 | 28.4% | 1.02 | 0.84 to 1.25 |
| Small vessel occlusion | 171 | 17.8% | 149 | 14.1% | 1.26 | 0.99 to 1.60 |
| Dissections | 45 | 4.7% | 30 | 2.8% | 1.61* | 1.01 to 2.58 |
| Other determined | 38 | 4.0% | 48 | 4.5% | 0.83 | 0.54 to 1.28 |
| Undetermined mechanism | 89 | 9.3% | 93 | 8.8% | 1.01 | 0.74 to 1.37 |
| Multiple mechanisms | 46 | 4.8% | 54 | 5.1% | 0.89 | 0.60 to 1.34 |
| PFO as likely cause | 35 | 3.6% | 36 | 3.4% | 1.03 | 0.64 to 1.65 |
| Reason: time | ||||||
| Too late intravenous | 25 | 2.6% | 26 | 2.5% | 1.04 | 0.59 to 1.81 |
| Too late intravenous and no indication intra-arterial | 127 | 13.2% | 76 | 7.2% | 1.92* | 1.42 to 2.59 |
| Too late intravenous and intra-arterial | 209 | 21.8% | 209 | 19.7% | 1.10 | 0.88 to 1.36 |
| Unknown onset | 268 | 27.9% | 399 | 37.6% | 0.62* | 0.51 to 0.74 |
| Total | 629 | 65.6% | 710 | 67.0% | 0.86 | 0.72 to 1.04 |
| Reason: severity | ||||||
| Too mild | 442 | 46.1% | 497 | 46.9% | 0.97 | 0.82 to 1.16 |
| Too severe | 20 | 2.1% | 5 | 0.5% | 4.37* | 1.63 to 11.70 |
| Rapid improvement to below threshold | 16 | 1.7% | 2 | 0.2% | 8.73* | 2.00 to 38.08 |
| Total | 478 | 49.8% | 489 | 46.1% | 1.10 | 0.92 to 1.32 |
| Reason: age | ||||||
| >80 years | 183 | 19.1% | 102 | 9.6% | 2.15* | 1.66 to 2.79 |
| Reason: imaging | ||||||
| Too large infarct | 0 | 0.0% | 32 | 3.0% | 30.24*§, p=0.000 | |
| Too little penumbra | 6 | 0.6% | 6 | 0.6% | 1.08 | 0.35 to 3.35 |
| Too large infarct and too little penumbra | 0 | 0.0% | 7 | 0.7% | 6.53*¶ , p=0.016 | |
| Subacute infarct on imaging | 6 | 0.6% | 12 | 1.1% | 0.53 | 0.20 to 1.43 |
| Other/intracranial haemorrhage | 3 | 0.3% | 20 | 1.9% | 0.16* | 0.05 to 0.54 |
| Total | 15 | 1.6% | 77 | 7.3% | 0.20* | 0.11 to 0.34 |
| Reason: high bleeding risk | ||||||
| INR elevated | 98 | 10.2% | 76 | 7.2% | 1.43* | 1.05 to 1.96 |
| Thrombocytopenia | 1 | 0.1% | 5 | 0.5% | 0.21 | 0.02 to 1.84 |
| Recent intervention | 5 | 0.5% | 14 | 1.3% | 0.38 | 0.14 to 1.06 |
| Previous intracranial haemorrhage | 5 | 0.5% | 12 | 1.1% | 0.45 | 0.16 to 1.27 |
| Intracranial vascular malformation | 6 | 0.6% | 8 | 0.8% | 0.81 | 0.28 to 2.33 |
| Other | 3 | 0.3% | 21 | 2.0% | 0.15* | 0.04 to 0.51 |
| Full dose heparin or LMWH | 5 | 0.5% | 15 | 1.4% | 0.36* | 0.13 to 0.98 |
| Total | 123 | 12.8% | 151 | 14.2% | 0.86 | 0.66 to 1.11 |
| Reason: other | ||||||
| No good reason according to hospital recommendations | 32 | 3.3% | 25 | 2.4% | 1.39 | 0.82 to 2.36 |
| Recent stroke | 25 | 2.6% | 26 | 2.5% | 1.04 | 0.59 to 1.81 |
| Stroke uncertain | 10 | 1.0% | 48 | 4.5% | 0.22* | 0.11 to 0.43 |
| Epileptic seizure | 5 | 0.5% | 8 | 0.8% | 0.67 | 0.22 to 2.06 |
| Comorbidity/dependency | 21 | 2.2% | 64 | 6.0% | 0.34* | 0.20 to 0.56 |
| Other | 13 | 1.4% | 13 | 1.2% | 1.08 | 0.50 to 2.33 |
| Total | 106 | 11.1% | 184 | 17.4% | 0.57* | 0.44 to 0.74 |
Asterisk (*), significant on p<0.05 level. Definitions of reasons for non-thrombolysis see text/table 5.
†TOAST17 classification.
‡Ipsilateral internal carotid stenosis <50%(NASCET)/risk factors for atherosclerotic disease, for details see PERFORM definition.18
§χ2 test.
¶Fisher's exact test (expected cell frequency <5).
INR, international normalised ratio; LMWH, low molecular weight heparin; NIHSS, National Institute of Health Stroke Scale score; PFO, patent foramen ovale; TOAST, TOAST, Trial of Org 10172 in Acute Stroke Treatment.