Background The likelihood of severe disability and death increases with each recurrent stroke. Repeated intravenous (IV) thrombolysis remains one of the therapeutic options when secondary prevention fails; however, its effects after recurrent stroke are largely unknown. The aim of the present review was to assess the risks and benefits of IV re-thrombolysis after recurrent stroke as compared with IV thrombolysis after index stroke. Methods We identified 8 patients who repeated IV thrombolysis after recurrent stroke from among the 615 consecutive stroke patients who received IV thrombolysis at our Stroke Unit and 22 cases of IV re-thrombolysed patients extracted for the literature review of case reports and case series. Results After excluding the 6 patients treated with endovascular procedures, we included in the analyses 21 patients for which we had data on pre-stroke functional status and baseline neurological severity for each stroke event and post-treatment functional status for each IV thrombolysis. We compared second (n = 21) and third (n = 3) IV thrombolytic treatments with first IV thrombolytic treatments (n = 21). Also, we compared IV thrombolytic re-treatments ≤ 3 months from previous IV thrombolysis (n = 10) with those > 3 months (n = 14). No significant differences in the rate of intracranial hemorrhage with neurological deterioration, mortality and restitution of the pre-existing functional status were observed in the comparative analyses. Conclusions IV re-thrombolysis may be safe and effective when recurrent stroke occurs after a period of complete neurologic regression lasting at least 24 h or minor disability (mRS score ≤ 2) lasting at least 3 months since the previous stroke.

Repeated intravenous thrombolysis after recurrent stroke. A case series and review of the literature.

CAPPELLARI, Manuel;MORETTO, Giuseppe;BOVI, PAOLO
2014

Abstract

Background The likelihood of severe disability and death increases with each recurrent stroke. Repeated intravenous (IV) thrombolysis remains one of the therapeutic options when secondary prevention fails; however, its effects after recurrent stroke are largely unknown. The aim of the present review was to assess the risks and benefits of IV re-thrombolysis after recurrent stroke as compared with IV thrombolysis after index stroke. Methods We identified 8 patients who repeated IV thrombolysis after recurrent stroke from among the 615 consecutive stroke patients who received IV thrombolysis at our Stroke Unit and 22 cases of IV re-thrombolysed patients extracted for the literature review of case reports and case series. Results After excluding the 6 patients treated with endovascular procedures, we included in the analyses 21 patients for which we had data on pre-stroke functional status and baseline neurological severity for each stroke event and post-treatment functional status for each IV thrombolysis. We compared second (n = 21) and third (n = 3) IV thrombolytic treatments with first IV thrombolytic treatments (n = 21). Also, we compared IV thrombolytic re-treatments ≤ 3 months from previous IV thrombolysis (n = 10) with those > 3 months (n = 14). No significant differences in the rate of intracranial hemorrhage with neurological deterioration, mortality and restitution of the pre-existing functional status were observed in the comparative analyses. Conclusions IV re-thrombolysis may be safe and effective when recurrent stroke occurs after a period of complete neurologic regression lasting at least 24 h or minor disability (mRS score ≤ 2) lasting at least 3 months since the previous stroke.
Repeated, Thrombolysis, Fibrinolysis, Recombinant tissue-type plasminogen activator, Alteplase, Recurrent stroke
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/836964
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