Repeated Use of tPA for Recurrent Ischaemic Stroke Is Safe

How long before your hospital implements this? 
https://www.docguide.com/repeated-use-tpa-recurrent-ischaemic-stroke-safe?hash=7e422beb&eid=63891&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c

: Presented at AAN

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• Stroke
• tPA

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By Alex Morrisson

LOS ANGELES -- April 29, 2018 -- A second course of tissue plasminogen activator (tPA) for a patient who has a recurrent stroke appears to present no increased risk of bleeding into the brain, according to a study presented here at the 2018 Annual Meeting of the American Academy of Neurology (AAN).

The odds ratio (OR) for an intracerebral haemorrhage when delivering a second tPA injection was 0.8 (95% confidence interval [CI], 0.5-1.3; P = .38).

After adjusting for demographics, vascular risk factors and the Elixhauser Comorbidity Index, the risk of death after using tPA a second time was also not significantly different than not using the agent (OR = 0.7; 95% CI, 0.5-1.1; P = .13).

There are no randomised studies that give guidance on the use of tPA when a patient returns to the hospital with a second stroke, according to Yahya Atalay, MD, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York.

“We identified all adults with acute ischaemic stroke who received tPA in California, New York, and Florida hospitals from 2005 to 2013 using the International Classification of Diseases, 9th Revision, Clinical Modification codes,” he said.

The researchers reviewed data from 35,307 patients with acute ischaemic stroke treated with tPA. Of that group, they identified 385 (1.1%) patients who received tPA previously for an acute stroke. Of all patients who received tPA, the rate of intracerebral haemorrhage was 5.9% and the mortality rate was 11.6%.

“Repeated use of intravenous tPA was not associated with an increased risk of intracerebral haemorrhage or death in patients with recurrent acute ischemic stroke,” said Dr. Atalay. “We believe our findings are thought-provoking and may lead to further studies looking at recurrent use of intravenous tPA. Since approximately 25% of all strokes are recurrent strokes, this is an important area of research.”

He noted that his study did not analyse if there was an interval between tPA doses that appeared to make the repeated administration safe, but the researchers plan to look into it soon.

[Presentation title: Safety of Repeated Use of Intravenous Thrombolysis for Recurrent Acute Ischemic Stroke. Abstract 007]