Deans' stroke musings: The use of alteplase, although safe, does not offer clear clinical advantages when mild stroke is non-disabling

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, July 20, 2023

The use of alteplase, although safe, does not offer clear clinical advantages when mild stroke is non-disabling

Did you ask your patients if your definition of non-disabling matches theirs? I thought not.

There are NO strokes that are too good to treat. Do you ever talk to stroke survivors about leaving them disabled because you did NOTHING?

The use of alteplase, although safe, does not offer clear clinical advantages when mild stroke is non-disabling

Giovanni Merlino^1,2^*^†,

Lorenzo Nesi²^†,

Pietro Vergobbi²,

Marco Domenico Scanni²,

Sara Pez²,

Alessandro Marziali²,

Yan Tereshko²,

Giuseppe Sportelli²,

Simone Lorenzut¹,

Francesco Janes^1,2,

Gian Luigi Gigli³ and

Mariarosaria Valente^2,3

¹Stroke Unit, Department of Head-Neck and Neuroscience, Udine University Hospital, Udine, Italy
²Clinical Neurology, Udine University Hospital, Udine, Italy
³Dipartimento di Area Medica (DAME), University of Udine, Udine, Italy

Introduction: It is unknown whether alteplase is effective and safe in patients with mild acute ischemic stroke (AIS). Determining whether symptoms are “disabling” or not is a crucial factor in the management of these patients. This study aimed to investigate the efficacy and safety of alteplase in patients with mild, non-disabling AIS.

Methods: We included all consecutive patients admitted for AIS at our institution from January 2015 to May 2022 who presented a baseline NIHSS score of 0–5 and fit the criteria to receive intravenous thrombolysis. In order to select only subjects with non-disabling AIS, we excluded patients who scored more than 1 point in the following NIHSS single items: vision, language, neglect, and single limb. Patients who scored at least 1 point in the NIHSS consciousness item were excluded as well. This study is a retrospective analysis of a prospectively collected database.

Results: After the application of the exclusion criteria, we included 319 patients, stratified into patients receiving and not receiving alteplase based on non-disabling symptoms. The two groups were comparable regarding demographic and clinical data. Rates of a 3-month favorable outcome, defined as a 3-month mRS score of 0–1, were similar, being 82.3% and 86.1% in the treated and untreated patients, respectively. Hemorrhagic complications and mortality occurred infrequently and were not affected by alteplase treatment.

Discussion: This observational study suggests that the use of alteplase, although safe, is not associated with a better outcome in highly selected patients with non-disabling AIS.