ABSTRACT
AIM AND METHODS: In an open, observational study, 40 consecutive ischemic stroke patients eligible for thrombolytic therapy using the combined ECASS/NINDS inclusion criteria have been treated intravenously with 1.5 M units of streptokinase. The therapeutic window was 3 hours or shorter. RESULTS: The safety analysis documented a low rate (5%) of intracerebral hemorrhages, and an additional 13% rate of hemorrhagic transformation of the initial infarction. Two patients died due to intracerebral bleeding. The efficacy of the SK thrombolysis was significant in 53% of the patients (the mean of the improvement on the NIH stroke scale was 15 points), while an other 42% of the patients achieved only the mean of 4 points improvement on their NIHSS score. DISCUSSION: These results are of the same magnitude, as those documented in the NINDS trial with rt-PA. Time window rather than the thrombolytic agent itself seems to be the decisive factor for successful thrombolysis. CONCLUSION: The good safety profile of SK in acute stroke using the ECASS/NINDS criteria, and the cost-effectiveness of the drug underline the necessity of a new SK trial with the recently accepted inclusion and exclusion criteria.
Subject(s)
Brain Ischemia/complications , Fibrinolytic Agents/administration & dosage , Plasminogen Activators/administration & dosage , Streptokinase/administration & dosage , Stroke/drug therapy , Thrombolytic Therapy , Adult , Aged , Aged, 80 and over , Brain Ischemia/diagnostic imaging , Contraindications , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Stroke/diagnostic imaging , Stroke/etiology , Thrombolytic Therapy/methods , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
INTRODUCTION: The authors summarised their experiences of systemic intravenous thrombolysis using recombinant tissue-type plasminogen activator with 3 hours therapeutic window in acute ischaemic stroke. AIM: The aim of this work was to test the safety and efficacy of systemic thrombolysis in our unselected, community-based patient population. RESULTS: The mean door-to-needle time was 45 minutes, the number of bleeding complications and successful recanalisation was similar to the results of the large international trials. In spite of these facts the functional outcome of our patients turned out to be worse. Compared to the baseline characteristics of the international trials the initial neurological deficit--a well known bad prognostic parameter- and also the comorbidity of our patients was more severe. CONCLUSION: In Hungary only patients with alarming, initial symptoms arrive quickly enough for thrombolysis to the hospital, while in most of the patients with less severe stroke symptoms the delay for hospital admission is more than 3 hours. The authors assume that with more effective patient education it might be possible to solve this problem and make thrombolysis to exert a greater impact on the effectiveness of the acute stroke therapy.
