The efficacy and safety of intravenous thrombolysis with alteplase in the treatment of ischaemic stroke in a rural hospital

Abstract

Background and purpose

Ongoing evaluation of the results of thrombolytic therapy in patients with ischaemic stroke (IS) in regions with different health care organization is absolutely crucial for making this method of treatment safer and efficient. The aim of this study was to analyse the efficacy and safety of treatment with intravenous alteplase in patients with acute IS in a rural hospital.

Material and methods

Between 2006 and 2011, 1392 patients with IS were treated (including 200 patients treated with alteplase; 14.37%). In patients treated with alteplase, we analysed the influence of several variables on the functional status after 3 months according to the modified Rankin Scale (mRS), case-fatality rate during 3 months after onset and symptomatic intracerebral haemorrhage (SICH).

Results

In the studied population, good outcome (mRS 0–2) at 3 months was related to younger age (p = 0.001), male sex (p = 0.02) and low scores (< 15 points) on the National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001). Deaths within 3 months were related to older age (p = 0.027), female sex (p = 0.004), severity of stroke measured by NIHSS score (p < 0.0001) and presence of radiological signs of previous stroke in baseline computed tomography (CT) (p = 0.002). Patients with SICH had higher mean age (p = 0.014) and higher severity of neurological deficit measured on the NIHSS scale (p = 0.03).

Conclusions

The indications for intravenous thrombolysis in patients with IS should be strictly analysed so that the treatment is effective and safe especially in older patients, patients with greater severity of neurological symptoms and patients with old post-stroke lesions in baseline CT.