Hostname: page-component-78c5997874-4rdpn Total loading time: 0 Render date: 2024-11-17T19:16:02.042Z Has data issue: false hasContentIssue false
  • English
  • Français

Doubts, Fears and Misconceptions. What is the Future of Thrombolysis in Acute Stroke?

Published online by Cambridge University Press:  02 December 2014

Philip A. Barber ,
Michael D. Hill ,
Andrew M. Demchuk  and
Alastair M. Buchan
Philip A. Barber
Affiliation:
Calgary Regional Stroke Program, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
Michael D. Hill
Affiliation:
Calgary Regional Stroke Program, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
Andrew M. Demchuk
Affiliation:
Calgary Regional Stroke Program, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
Alastair M. Buchan
Affiliation:
Calgary Regional Stroke Program, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Alteplase for acute ischemic stroke may be the first stroke intervention to have a significant public health impact. In February 1999, this therapy was conditionally licensed in Canada for acute ischemic stroke within three hours of symptom onset. However, considerable controversy exists regarding its safety, its wider applicability outside clinical trials, and its ultimate availability. In this article we review the thrombolytic literature, attempt to answer many of the concerns, provide new guidelines for its use, and cite the need for more information about whom we should and should not be treating with this therapy.

Résumé:

RÉSUMÉ:

L'alteplase en phase aiguë de l'accident vasculaire cérébral (AVC) ischémique est peut-être la première intervention dans l'AVC qui aura un impact significatif sur la santé publique. En février 1999, ce traitement a reçu une approbation conditionnelle au Canada pour le traitement de l'AVC ischémique aigu, moins de trois heures après le début des symptômes. Cependant, la sécurité du produit, son applicabilité en dehors d'essais thérapeutiques et sa disponibilité éventuelle sont très controversées. Dans cet article, nous revoyons la littérature sur la thrombolyse, nous tentons de répondre à plusieurs préoccupations, nous fournissons de nouvelles lignes directrices pour son utilisation et nous soulignons la nécessité de mieux définir les indications et les contre-indications à ce traitement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 27 , Issue 4 , November 2000 , pp. 283 - 287
Copyright
Copyright © The Canadian Journal of Neurological Sciences Inc. 2000

References

1. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333:1581–1587.Google Scholar
2. Adams, HP, Brott, TG, Furlan, et al. Guidelines for thrombolytic therapy for acute ischemic stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. Stroke 1996; 27: 1711–1718.Google Scholar
3. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Practice advisory: thrombolytic therapy for acute ischemic stroke – Summary Statement. Neurology 1996; 47: 835–839.Google Scholar
4. Hacke, W, Kaste, M, Fieschi, C, et al, for the ECASS Study Group. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274:1017–1025.Google Scholar
5. Hacke, W, Kaste, M, Fieschi, C, et al. Randomised double blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352: 1245–1251.Google Scholar
6. Clark, WM, Wissman, S, Albers, GW, et al. Recombinant tissue-type plasminogen activator for ischemic stroke 3-5 hours after symptom onset. JAMA 1999;282:2019–2026.Google Scholar
7. Caplan, LR, Mohr, JP, Kistler, JP, Koroshetz, , Grotta, J. Clinical debate: should thrombolytic therapy be the first-line treatment for acute ischemic stroke? N Engl J Med 1997;337: 1309–1313.Google Scholar
8. Devuyst, D, Bogouslavsky, J. Recent progress in drug treatment for acute stroke. J Neurol Neurosurg Psychiatry 1999; 67 (4): 420–425.Google Scholar
9. Hill, MD, Barber, PA, Buchan, AM for the CASES Investigators. The Canadian Activase for Stroke Effectiveness Study (abstract). Stroke 2000: 31: 315 Google Scholar
10. Kwiatkowski, TG, Libman, RB, Frankel, M, et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. N Engl J Med 1999; 340:1781–1787.Google Scholar
11. Haley, Jr, Lrwnadowski, C, Tilley, BC. NINDS rt-PA Stroke Study Group. Myths regarding the NINDS rt-PA Stroke Trial: Setting the record straight. Ann Emerg Med 1997;30:676–682.Google Scholar
12. Wardlaw, JM, Yamaguchi, T, del Zoppo, G. Thrombolytic therapy versus control in acute ischaemic stroke. Stroke module of the Cochrane Database of Systematic Reviews. Available in the Cochrane Library (database on disk and CDROM). Oxford: Update software, 1999.Google Scholar
13. von Kummer, R, Allen, KL, Holle, R, et al. Acute stroke: usefulness of early CT findings before thrombolytic therapy. Radiology 1997; 205: 327–333 Google Scholar
14. Barber, PA, Demchuk, AM, Zhang, J, Buchan, AM on behalf of the ASPECTS study group. The validity and reliability of a quantitative CTscore predicts outcome in hyperacute stroke prior to thrombolytic therapy. Lancet 2000;355:1670–1674.Google Scholar
15. Tanne, D, Demchuk, A, Kasner, S, Grond, M, et al. A large multinational investigation to predict t-PA related symptomatic ICH in patients with acute ischemic stroke (abstract). Stroke 1999;30:248.Google Scholar
16. Hanson, SK, Brauer, DJ, Anderson, DC, et al. Stroke treatment in the community (STIC) – Intravenous rt-PA therapy for acute stroke in clinical practice. Neurology 1998; 50:A155 (abstract).Google Scholar
17. Barnett, HJ, Taylor, DW, Eliasziw, , et al. Benefit of carotid endarterectomy in patients with symptomatic or severe stenosis. North American Symptomatic Carotid Endarterectomy Collaborators. N Engl J Med 1998;339:1415–1425.Google Scholar
18. Risk factors for stroke and efficacy of antithrombotic therapy in atrial fibrillation. Analysis of pooled data from five randomised controlled trials. Arch Intern Med 1994;154:1449–57.Google Scholar
19. Buchan, AM, Barber, PA, Karbalai, HG, et al. Effectiveness of t-PAin acute ischemic stroke: outcome relates to appropriateness. Neurology 2000; 54:679–684.Google Scholar
20. Jorgenson, HS, Nakayama, H, Kammersgaard, LP, Raaschou, HO, Olsen, TS. Predicted impact of intravenous thrombolysis on prognosis of general population of stroke patients: simulation model. Br Med J 1999; 919: 288–289.Google Scholar
21. Doorey, AJ, Michelson, EL, Topol, EJ. Thrombolytic therapy of acute myocardial infarction. JAMA 1992;268(21):3108–3114.Google Scholar
22. Marler, J, Tilley, B, Mei, L, et al. Earlier treatment associated with better outcome in the NINDS TPA stroke study (abstract). Stroke 1999; 30:244.Google Scholar
23. Grond, M, Rudolf, J, Schmulling, S, et al. Can the NINDS results be transferred into daily routine? Stroke 1998;29:288 (abstract).Google Scholar
24. Norris, J, Buchan, AM, Cote, R, et al. Canadian guidelines for intravenous thrombolytic treatment with acute stroke. Can J Neurol Sci 1998; 25: 257–259.Google Scholar
25. Hill, MD, Barber, PA, Demchuk, AM, et al. The Calgary Regional Stroke Program: Building a brain attack team for thrombolytic therapy in acute ischaemic stroke. Can Med Assoc J 2000;162(11):1589–1593.Google Scholar
26. Dippel, DWJ, Du, RY, van Beest Holle, M, et al. The validity and reliability of early infarct signs on CT in acute ischaemic stroke. Cerebrovas Dis 1997;7 (suppl 4):15.Google Scholar
27. Schriger, D, Kalafut, M, Starkman, S, et al. Cranial computed tomography interpretation in acute stroke. Physicians accuracy in determining eligibility for thrombolytic therapy. JAMA 1998; 279:1293–1297.Google Scholar
28. Grotta, J, Chiu, D, Lu, M, Patel, S, et al. Agreement and variabilty in the interpretation of early CT changes in stroke patients qualifying for intravenous rt-PA. Stroke 1999;30:1528–1533.Google Scholar
29. Wardlaw, JM, Dorman, PJ, Lewis, SC, Sandercock, PAG. Can stroke physicians and neurologists identify signs of early cerebral infarction on CT? J Neurol Neurosurg Psychiatry 1999; 67:651–653.Google Scholar
30. Beaulieu, C, de Crespigny, A, Tong, DC, et al. Longitudinual magnetic resonance imaging study of perfusion and diffusion in stroke: evolution of lesion volume and correlation with clinical outcome. Ann Neurology. 1999;46:568–578.Google Scholar
31. Yamaguchi, T, Mori, E, Minematsu, K, del Zoppo, , eds. Thrombolytic Therapy in Acute Ischemic Stroke III. Tokyo: Springer-Verlag, 1995.Google Scholar
32. Furlan, A, Higashida, R, Wechsler, L, et al. Intra-arterial prourokinase for acute ischemic stroke. The PROACT II study: a randomised controlled trial. JAMA 1999; 282: 2003–2011.Google Scholar
33. Anonymous. Royal College of Physicians of Edinburgh consensus conference on medical management of stroke, 26 and 27 May 1998. J Neurol Neurosurg Psychiatry 1999; 66:128–129.Google Scholar