Thrombolysis for acute ischemic stroke

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Thrombolysis for acute ischemic stroke Karim Hajjar, MD, Daniel M. Kerr, BSc, Kennedy R. Lees, MD, FRCP Journal of Vascular Surgery Volume 54, Issue 3, Pages 901-907 (September 2011) DOI: 10.1016/j.jvs.2011.04.062 Copyright © 2011 Terms and Conditions

Fig 1 Relation of onset to treatment delay with treatment effect, based on results from eight RCTs. Relation of stroke onset to start of treatment (OTT) with treatment effect after adjustment for prognostic variables assessed by (A) day 90 modified Rankin score 0–1 versus 2–6; (B) global test that incorporates modified Rankin score 0–1 versus 2–6, Barthel Index score 95–100 versus 90 or lower and NIHSS score 0–1 versus 2 or more; (C) mortality; and (D) parenchymal hemorrhage type 2 (large intracranial hemorrhage). Thus, for parenchymal hemorrhage type 2, the fitted line is not statistically distinguishable from a horizontal line. For each graph, the adjusted odds ratio (OR) is shown with the 95% OR of excellent outcomes (mRS 0-1) at 90 days: 0-90 min = 2.55 (1.44-4.52); 91-180 min = 1.64 (1.12-2.40); 181- 270 min = 1.34 (1.06-1.68); 271-360 min = 1.22 (0.92- 1.61); 0-360 min = 1.40 (1.20- 1.63) OR for mortality with alteplase treatment increases with time. OR for hemorrhagic complications shows no clear trend with time. Reproduced with permission from Lees et al17 and The Lancet. Journal of Vascular Surgery 2011 54, 901-907DOI: (10.1016/j.jvs.2011.04.062) Copyright © 2011 Terms and Conditions

Fig 2 Effect of age on benefit of thrombolysis. Controlled comparison of thrombolysed patients from the Safe Implementation of Treatment in Stroke - International Stroke Thrombolysis Registry (SITS-ISTR) with non-thrombolysed controls from the Virtual International Stroke Trials Archive (VISTA). Overall outcome is worse in patients aged over 80, but the benefit of treatment with alteplase on outcome is maintained. Reproduced with permission from Lees et al23 and British Medical Journal. Journal of Vascular Surgery 2011 54, 901-907DOI: (10.1016/j.jvs.2011.04.062) Copyright © 2011 Terms and Conditions

Fig 3 Forest plot comparing the effect of intra-arterial thrombolysis (IAT) versus control for middle cerebral artery stroke in the 6 hour window after acute ischaemic stroke, based on the results of three RCTs. MELT, Middle Cerebral Artery Embolism Local Fibrinolytic Trial Intervention; PROACT, Prolyse in Acute Cerebral Thromboembolism trial; SICH, symptomatic intracranial hemorrhage. Journal of Vascular Surgery 2011 54, 901-907DOI: (10.1016/j.jvs.2011.04.062) Copyright © 2011 Terms and Conditions