Intravenous Thrombolysis Attenuates Neurologic Deterioration After Ischemic Stroke

INTRODUCTION Although intravenous tissue plasminogen activator (IV tPA) is associated with neurologic deterioration (ND) caused by hemorrhage, whether it attenuates deterioration as a result of other etiologies including progressive stroke remains unexplored. The objective of this study was to determine whether IV tPA is associated with a reduced risk of ND caused by progressive stroke. METHODS A retrospective investigation of consecutively admitted patients with acute ischemic stroke (July 2008-June 2014) within 4.5 hours of symptom onset was conducted at a tertiary care center. Patients treated with IV tPA were compared with those who were not. The primary outcome was ND resulting from progressive infarction (a two-point increase in the National Institutes of Health Stroke Scale score during a 24-hour period). RESULTS A total of 699 registry patients (median age 65 years, interquartile range 55-76, 48.4% women, 70.4% nonwhite) were included in the study, and 58.1% received IV tPA. In crude regression, IV tPA did not reduce the odds of ND caused by progressive infarction; however, IV tPA-treated patients were at a 55% lower odds of ND from any cause (odds ratio 0.45, 95% confidence interval 0.32-0.61, P < 0.001). After adjusting for covariates, IV tPA use remained strongly associated with a 39% lower odds of ND from any cause (odds ratio 0.61, 95% confidence interval 0.48-0.79, P < 0.001). CONCLUSIONS Although IV tPA did not correlate with a reduced odds of progressive infarction, it was significantly associated with a lower odds of ND by any mechanism.