Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up

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Background and Purpose: IV thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery since clinical trials follow-up times are limited.Methods: Patients registered between Jan-2005 and Dec-2015 to the population-based South London Stroke Register of first-ever strokes. Propensity score was employed to match thrombolyzed and control cases to a 1:2 ratio by demographical and clinical covariates. The primary outcome was survival up to 10 years using Kaplan-Meier estimates, Cox Proportional Hazards and Restricted Mean Survival Time. Secondary outcomes included stroke recurrence and functional status (Barthel Index and Frenchay Activities Index scores) at 5 years. Results: From 2,052 ischemic strokes, 246 treated patients were matched to 492 controls. Median follow-up time: 5.45 years (IQR 4.56). Survival was higher in the treatment group (median: 5.72 years) compared to control group (4.98 years, stratified log-rank test <0.001). The Number Needed to Treat (NNT) to prevent 1 death at 5 years was 12, and 20 at 10 years. After cox regression analysis, thrombolysis reduced risk of mortality by 37% (HR 0.63, 95%CI 0.48-0.82) at 10 years; however, after introducing a multiplicative interaction term into the model, mortality risk reduction was 42% (HR 0.58 95%CI 0.40-0.82) at 10 years for those arriving within 3 hours to the hospital. On average, in a 10-year period, treated patients lived one year longer than controls. At 5 years, thrombolysis was associated with independence (BI ≥90, OR 3.76 95%CI 1.22-13.34) and increased odds of a higher FAI (proportional OR 2.37 95%CI 1.16-4.91). There was no difference in stroke recurrence.Conclusion: Thrombolysis with IV alteplase is associated with improved long-term survival and functional status after ischemic stroke.
Original languageEnglish
Pages (from-to)607-613
Issue number3
Early online date12 Feb 2018
Publication statusPublished - 31 Mar 2018


  • Stroke
  • alteplase
  • thrombolysis


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