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Recombinant Tissue-Type Plasminogen Activator Improves Stroke Outcome
A DGReview of :"Early stroke treatment associated with better outcome: The NINDS rt-PA Stroke Study"
Neurology
12/29/2000
By Mark Greener
Patients who receive recombinant tissue-type plasminogen activator within 90 minutes of stroke onset are more likely to show improved outcomes.
These improvements in outcome were seen after both 24 hours and three months compared to those stroke patients who were treated with tissue-type plasminogen activator (rt-PA) after 91 to 180 minutes of stroke onset.
These findings were obtained from an analysis of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study.
The proportions of people who had intracranial haemorrhages and who showed a good outcome after three months follow-up were similar in the two arms. However, a greater proportion of patients who received rt-PA within 90 minutes improved by at least four points on the NIH Stroke Scale (NIHSS) 24 hours after stoke onset than did those who received the drug after 91 to 180 minutes.
This paper reports a further analyses that aimed to characterize any relationship between onset-to-treatment time and, firstly, outcome at three months, secondly, improvement after 24 hours, and, finally, intracranial haemorrhage within 36 hours.
Statistical analyses revealed that patients who received rt-PA within 90 minutes were more likely to show improvements after 24 hours and, after adjusting for NIHSS score, to have favourable outcomes after three months than those treated within 91 to 180 minutes. The adjusted odds ratio for a favourable outcome after three months among those who received rt-PA within 90 minutes was 2.11 compared to an odds ratio of 1.69 among those treated between 91 and 180 minutes.
After adjusting for baseline NIHSS score, onset-to-treatment time did not appear to influence the risk of intracranial haemorrhage within 36 hours. The authors suggest that this lack of effect many reflect the study's power.
The authors concluded that patients who receive rt-PA within 90 minutes of stroke onset are more likely to show an improvement after 24 hours and favourable outcome after three months compared to patients treated between 91 and 180 minutes.
"Early stroke treatment associated with better outcome: The NINDS rt-PA Stroke Study"
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