An Observational Study of Thrombolysis Outcomes in Wake-Up Ischemic Stroke Patients

Dulka Manawadu, Shankaranand Bodla, Jeff Keep, Jozef Jarosz, Lalit Kalra*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

46 Citations (Scopus)

Abstract

Background and Purpose-Wake-up ischemic stroke (WUIS) patients are not eligible for thrombolysis; the a priori hypothesis was that thrombolysis of selected WUIS patients who meet clinical and imaging criteria for treatment is associated with better outcomes.

Methods-The sample consisted of consecutive WUIS patients who fulfilled predefined criteria: (1) were last seen normal >4.5 hours and = 5; (3) No or early ischemic changes

Results-WUIS patients constituted 10.5% (193/1836) of all stroke admissions. Inclusion criteria were fulfilled by 122 (63%) patients, of whom 68 (56%) were thrombolysed. Thrombolysed and nonthrombolysed patients were comparable for baseline characteristics, but the median baseline National Institute of Health Stroke Scale score was higher in thrombolysed patients (9 versus 11.5; P=0.034). There was no difference in modified Rankin Scale 0 to 2 (25 [37%] versus 14 [26%]; P=0.346), death (10 [15%] versus 14 [26%]; P=0.122), and symptomatic intracerebral hemorrhage (2 versus 0; P=0.204) between thrombolysed and nonthrombolysed patients. After adjusting for age, sex, and baseline National Institute of Health Stroke Scale score thrombolysis was associated with odds ratio of 5.2 (95% confidence interval 1.3-20.3), P=0.017 for modified Rankin Scale 0 to 2 at 90 days and odds ratio of 0.09 (95% confidence interval 0.02-0.44), P=0.003 for death.

Conclusions-Thrombolysis in selected WUIS patients is feasible and may have potential of benefit. (Stroke. 2013;44:427-431.)

Original languageEnglish
Pages (from-to)427-431
Number of pages5
JournalStroke
Volume44
Issue number2
DOIs
Publication statusPublished - Feb 2013

Keywords

  • outcomes
  • thrombolysis
  • SCALE
  • TRIAL
  • wake-up stroke
  • THERAPY
  • stroke management
  • COMPUTED-TOMOGRAPHY
  • DOUBLE-BLIND
  • acute stroke

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