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Intravenous Tissue Plasminogen Activator in Stroke Mimics.
- Source :
-
Circulation. Cardiovascular quality and outcomes [Circ Cardiovasc Qual Outcomes] 2019 Aug; Vol. 12 (8), pp. e005609. Date of Electronic Publication: 2019 Aug 15. - Publication Year :
- 2019
-
Abstract
- Background: The necessity for rapid evaluation and treatment of acute ischemic stroke with intravenous tPA (tissue-type plasminogen activator) may increase the risk of administrating tPA to patients presenting with noncerebrovascular conditions that closely resemble stroke (stroke mimics). However, there are limited data on thrombolysis safety in stroke mimics.<br />Methods and Results: Using data from the Get With The Guidelines-Stroke Registry, we identified 72 582 patients with suspected ischemic stroke treated with tPA from 485 US hospitals between January 2010 and December 2017. We documented the use of tPA in stroke mimics, defined as patients who present with stroke-like symptoms, but after workup are determined not to have suffered from a stroke or transient ischemic attack, and compared characteristics and outcomes in stroke mimics versus those with ischemic stroke. Overall, 3.5% of tPA treatments were given to stroke mimics. Among them, 38.2% had a final nonstroke diagnoses of migraine, functional disorder, seizure, and electrolyte or metabolic imbalance. Compared with tPA-treated true ischemic strokes, tPA-treated mimics were younger (median 54 versus 71 years), had a less severe National Institute of Health Stroke Scale (median 6 versus 8), and a lower prevalence of cardiovascular risk factors, except for a higher prevalence of prior stroke/transient ischemic attack (31.3% versus 26.1%, all P<0.001). The rate of symptomatic intracranial hemorrhage was lower in stroke mimics (0.4%) as compared with 3.5% in ischemic strokes (adjusted odds ratio, 0.29; 95% CI, 0.17-0.50). In-hospital mortality rate was significantly lower in stroke mimics (0.8% versus 6.2%, adjusted odds ratio, 0.31; 95% CI, 0.20-0.49). Patients with stroke mimics were more likely to be discharged to home (83.8% versus 49.3%, adjusted odds ratio, 2.97; 95% CI, 2.59-3.42) and to ambulate independently at discharge (78.6% versus 50.6%, adjusted odds ratio, 1.86; 95% CI, 1.61-2.14).<br />Conclusions: In this large cohort of patients treated with tPA, relatively few patients who received tPA for presumed stroke were ultimately not diagnosed with a stroke or transient ischemic attack. The complication rates associated with tPA in stroke mimics were low. Despite the potential risk of administering tPA to stroke mimics, opportunity remains for continued improvement in the rapid and accurate diagnosis and treatment of ischemic stroke.
- Subjects :
- Administration, Intravenous
Adult
Aged
Aged, 80 and over
Brain Ischemia diagnosis
Brain Ischemia mortality
Brain Ischemia physiopathology
Diagnosis, Differential
Female
Fibrinolytic Agents adverse effects
Humans
Intracranial Hemorrhages chemically induced
Intracranial Hemorrhages epidemiology
Male
Middle Aged
Predictive Value of Tests
Registries
Risk Assessment
Risk Factors
Stroke diagnosis
Stroke mortality
Stroke physiopathology
Tissue Plasminogen Activator adverse effects
Treatment Outcome
United States
Brain Ischemia drug therapy
Fibrinolytic Agents administration & dosage
Stroke drug therapy
Thrombolytic Therapy adverse effects
Thrombolytic Therapy mortality
Tissue Plasminogen Activator administration & dosage
Unnecessary Procedures
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7705
- Volume :
- 12
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular quality and outcomes
- Publication Type :
- Academic Journal
- Accession number :
- 31412730
- Full Text :
- https://doi.org/10.1161/CIRCOUTCOMES.119.005609