Reasons and evolution of non-thrombolysis in acute ischaemic stroke

T. Reiff, Patrik Michel
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引用次数: 25

Abstract

Introduction Despite increasing evidence of its efficacy in advanced age or in mild or severe strokes, intravenous thrombolysis remains underused for acute ischaemic stroke (AIS). Our aim was to obtain an updated view of reasons for non-thrombolysis and to identify its changing patterns over time. Methods This is a retrospective study of prospectively collected data from the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) from the years 2003–2011. Patients admitted with acute stroke in the past 24 hours who had not had thrombolysis were identified; reasons for non-thrombolysis documented in the prospectively entered data were tabulated and analysed for the group as a whole. Data were analysed for the years 2003–2006 and 2007 forward because of changes in contraindications. A subgroup of patients who arrived within the treatment window ≤180 min was separately analysed for reasons for non-thrombolysis. Predictors of non-thrombolysis were investigated via multivariate regression analyses. Results In the 2019 non-thrombolysed patients the most frequent reasons for non-thrombolysis were admission delays (66.3%), stroke severity (mostly mild) (47.9%) and advanced age (14.1%); 55.9% had more than one exclusion criterion. Among patients arriving ≤180 min after onset, the main reasons were stroke severity and advanced age. After 2006, significantly fewer patients were excluded because of age (OR 2.65, p<0.001) or (mostly mild) stroke severity (OR 10.56, p=0.029). Retrospectively, 18.7% of all non-thrombolysed patients could have been treated because they only had relative contraindications. Conclusion Onset-to-admission delays remain the main exclusion criterion for thrombolysis. Among early arrivals, relative contraindications such as minor stroke severity and advanced age were frequent. Thrombolysis rate increased with the reduction of thrombolysis restrictions (eg, age and stroke severity).
急性缺血性脑卒中非溶栓的原因及演变
尽管越来越多的证据表明静脉溶栓在老年或轻度或重度卒中中的疗效,但静脉溶栓在急性缺血性卒中(AIS)中的应用仍然不足。我们的目的是获得非溶栓原因的最新观点,并确定其随时间的变化模式。方法回顾性分析2003-2011年洛桑急性卒中登记与分析(ASTRAL)的前瞻性数据。过去24小时内未进行溶栓治疗的急性脑卒中患者;前瞻性输入数据中记录的非溶栓原因被制表并对整个组进行分析。由于禁忌症的变化,分析了2003-2006年和2007年以后的数据。在治疗窗口≤180分钟内到达的患者亚组被单独分析非溶栓的原因。通过多元回归分析研究非溶栓的预测因素。结果2019年非溶栓患者中,最常见的非溶栓原因是入院延迟(66.3%)、脑卒中严重程度(以轻度为主)(47.9%)和高龄(14.1%);55.9%有一个以上的排除标准。发病后≤180 min到达的患者,主要原因为脑卒中严重程度和高龄。2006年以后,因年龄(OR 2.65, p<0.001)或(大多数为轻度)卒中严重程度(OR 10.56, p=0.029)而被排除的患者明显减少。回顾性分析,18.7%的非溶栓患者可以接受治疗,因为他们只有相对禁忌症。结论发病至入院延迟仍是溶栓的主要排除标准。在早期到达者中,相对禁忌症如轻微中风严重程度和高龄是常见的。溶栓率随着溶栓限制(如年龄和中风严重程度)的减少而增加。
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