JACC: Thrombolysis gets good grades after cath lab stroke

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Thrombolysis might improve early outcomes after post-catheterization strokes and seems safe, according to a study in the Journal of American College of Cardiology.

Pooja Khatri, MD, of the department of neurology at the University of Cincinnati, in Ohio, and colleagues began the investigation because thrombolysis has been established as an effective treatment for acute ischemic stroke, but its benefit and risk for ischemic strokes specifically in the cardiac catheterization setting have not previously been investigated.

Despite the availability of FDA-approved thrombolytic therapy for acute ischemic stroke since 1996, thrombolysis remains unestablished in the setting of cardiac catheterization, owing to unique concerns regarding safety and efficacy.

Seven academic centers with stroke teams from across the United States elected to participate in the study, according the researchers.

The authors wrote that a total of 66 cases of ischemic strokes after cardiac catheterization were identified over three to four years; 12 (18 percent) were treated with thrombolysis, consisting of seven intravenous and five intra-arterial recombinant tissue plasminogen activator cases.

The investigators found that the improvement in stroke symptoms was greater in treated cases compared to the nontreated cases. Additional secondary measures of efficacy also showed better outcomes in the treated group.

Khatri and colleagues reported that there were no significant differences in bleeding events, defined as symptomatic intracerebral hemorrhage; hemopericardium, or other systemic bleeding resulting in hemodynamic instability or blood tranfusions; and mortality rates were also similar.

In the study’s cohort, 18 percent were treated with thrombolytics, which is a far greater proportion than in the general stroke population, the researchers said.

Their findings suggest that thrombolysis might improve early outcome of stroke after cardiac catheterization (SCC) and seems relatively safe in this context.

Khatri and colleagues acknowledged that the study has limitations inherent in its retrospective design and modest sample size, and also in its inability to control for all potential baseline differences between the treated and untreated groups.

However, the authors said that the systematically collected, multicenter cohort of consecutive SCC patients provides compelling data to suggest that post-catheterization stroke patients might be opportune candidates for acute intervention, and emergent cerebral revascularization should be a routine consideration.

In the final recommendation, the investigators suggested that future large, prospective registries be created to further characterize this population.