Mixed outcomes noted in mild stroke treated with rtPA

A retrospective analysis of patients given recombinant tissue plasminogen activator (rtPA) to treat mild stroke found that while mortality was low, approximately 30 percent could not move about without help or go directly home.

The study, published online Feb. 2 in JAMA: Neurology, used the Get With The Guidelines—Stroke registry data from 2010 through 2012 for its analysis. Jose G. Romano, MD, from the neurology department at University of Miami Miller School of Medicine in Miami, and colleagues analyzed outcomes of patients with National Institutes of Health Stroke Scores (NIHSS) of 5 or less who were treated within a 4.5-hour window with rtPA.

Romano et al noted low complication rates among patients. Mortality, symptomatic intracranial hemorrhage, life-threatening or serious hemorrhage and other serious complication rates were 1.3 percent, 1.8 percent, 0.2 percent and 1.8 percent, respectively. However, 73 percent of hospital stays were three days or longer, 29.4 percent could not be discharged directly home, and 30.3 could not independently ambulate.

Short-term outcomes and treatment complications were similar for mild stroke patients regardless of whether they had been treated in less than 3 hours or between 3 and 4.5 hours. One-fifth of patients were treated in the extended window of 3 to 4.5 hours, they wrote.

Due to the paucity of data on rtPA in mild stroke patients and their short- and long-term outcomes, Romano et al called for randomized studies to further clarify risks. “However, given the significant proportion of treated mild stroke and real-world safety outcomes observed, our results provide reassurance about the safety of IV rtPA in patients with low NIHSS scores.”