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Reasons and evolution of non-thrombolysis in acute ischaemic stroke
  1. T Reiff1,
  2. P Michel2
  1. 1Department of Neurology, University of Heidelberg, Heidelberg, Germany
  2. 2Stroke Center, Neurology Service, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
  1. Correspondence to Dr Tilman Reiff, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, Heidelberg D-69120, Germany; tilman.reiff{at}med.uni-heidelberg.de

Abstract

Introduction Despite increasing evidence of its efficacy in advanced age or in mild or severe strokes, intravenous thrombolysis remains underused for acute ischaemic stroke (AIS). Our aim was to obtain an updated view of reasons for non-thrombolysis and to identify its changing patterns over time.

Methods This is a retrospective study of prospectively collected data from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) from the years 2003–2011. Patients admitted with acute stroke in the past 24 hours who had not had thrombolysis were identified; reasons for non-thrombolysis documented in the prospectively entered data were tabulated and analysed for the group as a whole. Data were analysed for the years 2003–2006 and 2007 forward because of changes in contraindications. A subgroup of patients who arrived within the treatment window ≤180 min was separately analysed for reasons for non-thrombolysis. Predictors of non-thrombolysis were investigated via multivariate regression analyses.

Results In the 2019 non-thrombolysed patients the most frequent reasons for non-thrombolysis were admission delays (66.3%), stroke severity (mostly mild) (47.9%) and advanced age (14.1%); 55.9% had more than one exclusion criterion. Among patients arriving ≤180 min after onset, the main reasons were stroke severity and advanced age. After 2006, significantly fewer patients were excluded because of age (OR 2.65, p<0.001) or (mostly mild) stroke severity (OR 10.56, p=0.029). Retrospectively, 18.7% of all non-thrombolysed patients could have been treated because they only had relative contraindications.

Conclusion Onset-to-admission delays remain the main exclusion criterion for thrombolysis. Among early arrivals, relative contraindications such as minor stroke severity and advanced age were frequent. Thrombolysis rate increased with the reduction of thrombolysis restrictions (eg, age and stroke severity).

  • neurology, stroke
  • research, clinical
  • stroke
  • thrombolysis
  • urgent care

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Footnotes

  • Contributors PM: designing data collection tools, monitoring data collection, conception and design of the study, interpretation of data, manuscript writing, final approval of the version to be published and responsible for the overall content as guarantor. TR: conception and design of the study, cleaning and statistical analysis of data, interpretation of data, manuscript writing, submitting and responsible for the overall content as guarantor.

  • Funding Swiss Heart Foundation.

  • Competing interests PM: speaker fees from Bayer, Pfizer, Medtronic, St Jude Medical and Boehringer Ingelheim; consulting fees from Pierre-Fabre and Amgen; honoraria from scientific advisory boards of Bayer, Pfizer and Boehringer Ingelheim.

  • Ethics approval Ethics Committee for Research on Humans of the canton of Vaud, sub-commission III.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All the data of this study are only available with the authors.

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