Neurol. praxi. 2014;15(3):120-124

Systemic intravenous thrombolysis of ischemic strokes - the best treatment alternative?

doc. MUDr. Miroslav Brozman, CSc.
Neurologická klinika, FN Nitra, Fakulta sociálnych vied a zdravotníctva, Univerzita Konštantína Filozofa, Nitra

Systemic intravenous thrombolysis is considered gold standard for the treatment of ischemic cerebral strokes up to 4,5 hours from the onset of symptoms. It´s efficacy and safety are greatest when given lege artis, i. e. at appropriate time, at appropriate dosis and to appropriate patient. Which time is the best? Which dosis is correct? Which patient is the best candidate? Is really systemic thrombolysis the best alternative of treatment for the patients with ischemic stroke? Do we have answers for all these questions? On the basis of recently published data and personal experience we discuss several aspects of this interesting topic.

Keywords: systemic intravenous thrombolysis, ischemic stroke, recombinant plasminogen, activator (rtPA)

Published: June 9, 2014  Show citation

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Brozman M. Systemic intravenous thrombolysis of ischemic strokes - the best treatment alternative? Neurol. praxi. 2014;15(3):120-124.
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    References

    1. Brozman M, Göbö T, Petrovičová A, Hajaš G, Frišová A, Filipová A, Miklošková M, Raisová M, Virágová M, Varga P, Pétery R, Kvasňovská J, Halaj M, Ruttkay A. Intravenózna rt-PA trombolýza akútnych mozgových infarktov: retrospektívna analýza 119 trombolýz v rokoch 1998 - 2005. Neurológia. 2006; 1(4): 32-33.
    2. Brozman M, Göbö T, Raisová M, Hajaš G, Petrovičová A, Frišová A, Varga P, Filipová A, Pétery R, Kvasňovská J, Miklošková M. Intravenous rt-PA thrombolytic therapy in fifty-six ischemic stroke patients - a prospective follow-up study. Acta Clin Croat. 2003; 42: 289-297.
    3. Ebinger M, Lindenlaub S, Kunz A, Rozanski M, Waldschmidt C, Weber JE, Wendt M, Winter B, Kellner PA, Kaczmarek S, Endres M, Audebert HJ. Prehospital thrombolysis: a manual from Berlin. J Vis Exp. 2013; (81). doi: 10.3791/50534. PMID: 24300505 [PubMed - in process]. Go to original source... Go to PubMed...
    4. Ebinger M, Rozanski M, Waldschmidt C, Weber J, Wendt M, Winter B, Kellner P, Baumann AM, Malzahn U, Heuschmann PU, Fiebach JB, Endres M, Audebert HJ. STEMO-Consortium. PHANTOM-S: the prehospital acute neurological therapy and optimization of medical care in stroke patients - study. Int J Stroke. 2012; 7(4): 348-353. doi: 10.1111/j.1747-4949.2011.00756.x. Epub 2012 Feb 2. Go to original source... Go to PubMed...
    5. Ebrahim S, Redfern J. Stroke Care: A Matter of Chance. A National Survey of Stroke Services. London, UK: The Stroke Association; 1999.
    6. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ichaemic attack. Cerebrovasc Dis. 2008;25:457-507. Go to original source... Go to PubMed...
    7. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee. Should the time window for intravenous thrombolysis be extended? 2009 [online]. Available from: <http://www.eso-stroke.org/pdf/ESO_Guideline_Update_Jan_2009>.
    8. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D. ECASS 3 Investigators. Thrombolysis with Alteplase 3 to 4,5 Hours after Acute Ischemic Stroke. N Engl J Med. 2008; 359: 1317-1329. Go to original source... Go to PubMed...
    9. Jauch JC, Saver JL, Adams HP, Bruno A, Connors JJ, Demaerschalk BM, Khatri P, McMullan PW Jr, Qureshi AI, Rosenfield K, Scott PA, Summers DR, Wang DZ, Wintermark M, Yonas H. American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the Early Management of Patients With Acute Ischemic Stroke. A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2013; 44(3): 870-947. Go to original source... Go to PubMed...
    10. Katzan IL, Sila CA, Furlan AJ. Community use of intravenous tissue plasminogen activator for acute stroke: results of the Brain Matters Stroke Management Survey. Stroke. 2001; 32: 861-865. Go to original source... Go to PubMed...
    11. Koga M, Shiokawa Y, Nakagawara J, Furui E, Kimura K, Yamagami H, Okada Y, Hasegawa Y, Kario K, Okuda S, Endo K, Miyagi T, Osaki M, Minematsu K, Toyoda K. Low-dose intravenous recombinant tissue-type plasminogen activator therapy for patients with stroke outside European indications: Stroke Acute Management with Urgent Risk-factor Assessment and Improvement (SAMURAI) rtPA Registry. Stroke. 2012 Jan; 43(1): 253-5. doi: 10.1161/STROKEAHA.111.631176. Epub 2011 Sep 29. Go to original source... Go to PubMed...
    12. Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, Albers GW, Kaste M, Marler JR, Hamilton SA, Tilley BC, Davis SM, Donnan GA, Hacke W; ECASS, ATLANTIS, NINDS and EPITHET rt-PA Study Group, Allen K, Mau J, Meier D, del Zoppo G, De Silva DA, Butcher KS, Parsons MW, Barber PA, Levi C, Bladin C, Byrnes G. Time to treatment with intravenous alteplase and outcome in stroke. Lancet. 2010; 375(9727): 1695-1703. Go to original source... Go to PubMed...
    13. Messé SR, Kasner SE, Cucchiara BL, Demchuk A, Tanne D, Ouyang B, Levine SR. NINDS t-PA Stroke Study Group. Dosing errors did not have a major impact on outcome in the NINDS t-PA st roke study. J Stroke Cerebrovasc Dis. 2011; 20: 236-240. Go to original source... Go to PubMed...
    14. Mikulík R, Reif M, Bar M, Goldemund D, Brichta J, Školoudík D, Kuliha M, Roubec M. Bezpečnost a účinnost nového schématu dávkování trombolýzy - pilotní studie. Česká a slovenská neurologie a neurochirurgie. 2013; 76(1): 76-80.
    15. Robinson TG, Reid A, Haunton VJ, Wilson A, Naylor AR. The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms [published online ahead of print July 4, 2012]. Emerg Med J. 2012; 30(6): 467-471. Go to original source... Go to PubMed...
    16. Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, Innes K, Venables G, Czlonkowska A, Kobayashi A, Ricci S, Murray V, Berge E, Slot KB, Hankey GJ, Correia M, Peeters A, Matz K, Lyrer P, Gubitz G, Phillips SJ, Arauz A. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the Third International Stroke Trial [IST-3]): a randomised controlled trial [published correction appears in Lancet. 2012;380:730]. Lancet. 2012; 379: 2352-2363. Go to original source... Go to PubMed...
    17. Saver JL, Fonarow GC, Smith EE, Reeves MJ, Grau-Sepulveda MV, Pan W, Olson DM, Hernandez AF, Peterson ED, Schwamm LH. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013; 309(23): 2480-2488. Go to original source... Go to PubMed...
    18. SITS register [online]. Available from: <http://www.sitsinternational.org>.
    19. Strbian D, Soinne L, Sairanen T, Häppölä O, Lindsberg PJ, Tatlisumak T, Kaste M. Helsinki Stroke Thrombolysis Registry Group. Ultraearly thrombolysis in acute ischemic stroke is associated with better outcome and lower mortality. Stroke. 2010; 41(4): 712-716. Go to original source... Go to PubMed...
    20. Školoudík D, Herzig R, Kuliha D. Systémová trombolýza u ischemického iktu - indikace a kontraindikace léčby. Neurológia. 2013; 8(1): 9-12.
    21. The 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: 1581-1588. Go to original source... Go to PubMed...
    22. Walter S, Kostopoulos P,Haass A, Keller I, Lesmeister M, Schlechtriemen T, Roth C, Papanagiotou P, Grunwald I, Schumacher H, Helwig S, Viera J, Körner H, Alexandrou M, Yilmaz U, Ziegler K, Schmidt K, Dabew R, Kubulus D, Liu Y, Volk T, Kronfeld K, Ruckes C, Bertsch T, Reith W, Fassbender K. Diagnosis and treatment of patients with stroke in a mobile stroke unit versus in hospital: a randomised controlled trial. Lancet Neurol. 11 (5), 397-404, doi: 10.1016/S1474-4422(12)70057-1 (2012). Go to original source... Go to PubMed...
    23. Weber JE, Ebinger M, Rozanski M, Waldschmidt C, Wendt M, Winter B, Kellner P, Baumann A, Fiebach JB, Villringer K, Kaczmarek S, Endres M, Audebert HJ; STEMO-Consortium. Pre-hospital thrombolysis in acute stroke -results of the PHANTOM-S pilot study. Neurology. ahead of print, doi: 10.1212/WNL.0b013e31827b90e5 (2012). Go to original source... Go to PubMed...
    24. Weber JE, Ebinger M, Rozanski M, Waldschmidt C, Wendt M, Winter B, Kellner P, Baumann A, Fiebach JB, Villringer K, Kaczmarek S, Endres M, Audebert HJ. STEMO-Consortium. Prehospital thrombolysis in acute stroke: results of the PHANTOM-S pilot study. Neurology. 2013; 80(2): 163-168. doi: 10.1212/WNL.0b013e31827b90e5. Epub 2012 Dec 5. PMID: 23223534 [PubMed - indexed for MEDLINE]. Go to original source... Go to PubMed...

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