Real-World Outcomes of Acute Ischemic Stroke Treatment with Intravenous Recombinant Tissue Plasminogen Activator

被引:31
作者
Betts, Keith A. [1 ]
Hurley, Dana [2 ]
Song, Jinlin [1 ]
Sajeev, Gautam [3 ]
Guo, Jenny [3 ]
Du, Ella Xiaoyan [1 ]
Paschoalin, Marco [4 ]
Wu, Eric Q. [3 ]
机构
[1] Anal Grp Inc, Los Angeles, CA USA
[2] HUTH Global LLC, Seattle, WA USA
[3] Anal Grp Inc, Boston, MA USA
[4] Genentech Inc, San Francisco, CA USA
关键词
Ischemic stroke; quality and outcomes; mortality/survival; recombinantn tissue plasminogen activator; HEALTH-CARE PROFESSIONALS; COST-EFFECTIVENESS; EARLY MANAGEMENT; FOLLOW-UP; ALTEPLASE; THROMBOLYSIS; GUIDELINES; MORTALITY; UPDATE;
D O I
10.1016/j.jstrokecerebrovasdis.2017.06.010
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Background and Purpose: In clinical trials, intravenous (IV) recombinant tissue-type plasminogen activator (rt-PA) reduces the likelihood of disability if given within 3 hours of acute ischemic stroke. This study compared real-world outcomes between patients treated and patients not treated with IV rt-PA. Methods: In this retrospective study, United States-based neurologists randomly selected eligible acute ischemic stroke patients from their charts who were and were not treated with IV rt-PA. Mortality, hospital readmission, and independence were compared between patients treated and patients not treated with IV rt-PA using Kaplan-Meier curves, log-rank tests, and Cox proportional hazards models. Results: A total of 1026 charts were reviewed with a median follow-up time of 15.5 months. Pretreatment stroke severity, as measured by the National Institutes of Health Stroke Scale, was comparable between cohorts (IV rt-PA = 11.7; non-rt-PA = 11.3; P =.165). IV rt-PA patients experienced significantly longer survival (P =.013), delayed hospital readmission (P =.012), and shorter time to independence (P <.001) compared with patients not treated with rt-PA. After adjusting for baseline characteristics, IV rt-PA patients had significantly lower mortality (hazard ratio [95% confidence interval] =.52 [. 30,.90]) and greater rates of independence (hazard ratio [95% confidence interval] = 1.42 [1.17, 1.71]) than patients not treated with rt-PA. Conclusions: This real-world study indicated that acute ischemic stroke patients treated with IV rt-PA experience long-term clinical benefits in survival and functional status.
引用
收藏
页码:1996 / 2003
页数:8
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