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OUTCOME OF THROMBOLYSIS AT 0-3 OR 3-4.5 HOURS AFTER ACUTE ISCHAEMIC STROKE – AN ANALYSIS OF OUTCOMES OVER 6 YEARS IN A REGIONAL NEUROSCIENCE CENTRE

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ESOC-2019

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Abstract

Introduction Intravenous thrombolysis within 4.5 hours from symptom onset for ischaemic stroke is a well-established treatment. We assessed our local performance over six years against published data. Methods We interrogated our regional database identifying all patients thrombolysed between 01/13-2/18. Thrombectomy patients were excluded. We compared outcomes between the 0-3 and 3-4.5 hour groups using discharge modified Rankin Scale (mRS), 24 hour significant neurological improvement (NIHSS improvement ≥8, or =0-1) or rate of symptomatic intracranial haemorrhage (sICH) comparing results to published data. Results Over six years, 806 patients received thrombolysis: 618 <3 hours and 188 between 3-4.5 hours. The two groups were similar in age, gender, baseline mRS, except the 0-3 hour group’s baseline NIHSS (9[5,17] vs. 8[5,14]; p=0.03 Mann-Whitney-U). Discharge mRS, 24-hour improvement & sICH were similar between groups. Patients >80 fared worse than younger in both 0-3 and 3-4.5 hour groups (p=0.003, 95%CI [0.16-0.78]; p=0.051, 95%CI [-0.002-1.1] respectively). Over 6 years, the proportion of patients with mRS 0-1 at discharge increased slightly (Figure). Fewer people in the 0-3 hour group or 3-4.5 hour group had discharge mRS 0-1 compared to NINDS (31% vs. 42.6%, p=0.007); or ECASS III respectively (33.1% vs. 52.4%, p<0.001 Chi-square). Discussion In our centre, patients receiving IV thrombolysis within 0-3 hours and 3-4.5 hours from symptoms onset had similar outcomes with improvement in our performance over six years. Our outcomes appear inferior to published data, as we had to use discharge mRS not 3-month mRS.

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© Copyright 2019 Morressier GmbH. All rights reserved.

© Copyright 2019 Morressier GmbH.
All rights reserved.