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dc.creatorTsivgoulis, G.en
dc.creatorZand, R.en
dc.creatorKatsanos, A. H.en
dc.creatorGoyal, N.en
dc.creatorUchino, K.en
dc.creatorChang, J.en
dc.creatorDardiotis, E.en
dc.creatorPutaala, J.en
dc.creatorAlexandrov, A. W.en
dc.creatorMalkoff, M. D.en
dc.creatorAlexandrov, A. V.en
dc.date.accessioned2015-11-23T10:52:10Z
dc.date.available2015-11-23T10:52:10Z
dc.date.issued2015
dc.identifier10.1161/strokeaha.115.009012
dc.identifier.issn0039-2499
dc.identifier.urihttp://hdl.handle.net/11615/34027
dc.description.abstractBackground and Purpose-Shortening door-to-needle time may lead to inadvertent intravenous thrombolysis (IVT) administration in stroke mimics (SMs). We sought to determine the safety of IVT in SMs using prospective, single-center data and by conducting a comprehensive meta-analysis of reported case-series. Methods-We prospectively analyzed consecutive IVT-treated patients during a 5-year period at a tertiary care stroke center. A systematic review and meta-analysis of case-series reporting safety of IVT in SMs and confirmed acute ischemic stroke were conducted. Symptomatic intracerebral hemorrhage was defined as imaging evidence of ICH with an National Institutes of Health Stroke scale increase of >= 4 points. Favorable functional outcome at hospital discharge was defined as a modified Rankin Scale score of 0 to 1. Results-Of 516 consecutive IVT patients at our tertiary care center (50% men; mean age, 60 +/- 14 years; median National Institutes of Health Stroke scale, 11; range, 3-22), SMs comprised 75 cases. Symptomatic intracerebral hemorrhage occurred in 1 patient, whereas we documented no cases of orolingual edema or major extracranial hemorrhagic complications. In meta-analysis of 9 studies (8942 IVT-treated patients), the pooled rates of symptomatic intracerebral hemorrhage and orolingual edema among 392 patients with SM treated with IVT were 0.5% (95% confidence interval, 0%-2%) and 0.3% (95% confidence interval, 0%-2%), respectively. Patients with SM were found to have a significantly lower risk for symptomatic intracerebral hemorrhage compared with patients with acute ischemic stroke (risk ratio=0.33; 95% confidence interval, 0.14-0.77; P=0.010), with no evidence of heterogeneity or publication bias. Favorable functional outcome was almost 3-fold higher in patients with SM in comparison with patients with acute ischemic stroke (risk ratio=2.78; 95% confidence interval, 2.07-3.73; P<0.00001). Conclusions-Our prospective, single-center experience coupled with the findings of the comprehensive meta-analysis underscores the safety of IVT in SM.en
dc.sourceStrokeen
dc.source.uri<Go to ISI>://WOS:000353559800038
dc.subjectintracranial hemorrhagesen
dc.subjectmisdiagnosisen
dc.subjectsafetyen
dc.subjectstrokeen
dc.subjecttissue-typeen
dc.subjectplasminogen activatoren
dc.subjectTISSUE-PLASMINOGEN ACTIVATORen
dc.subjectACUTE ISCHEMIC-STROKEen
dc.subjectTREATED PATIENTSen
dc.subjectPATIENTen
dc.subjectTPAen
dc.subjectHEMORRHAGEen
dc.subjectEMERGENCYen
dc.subjectOUTCOMESen
dc.subjectTHERAPYen
dc.subjectTRIALSen
dc.subjectClinical Neurologyen
dc.subjectPeripheral Vascular Diseaseen
dc.titleSafety of Intravenous Thrombolysis in Stroke Mimics Prospective 5-Year Study and Comprehensive Meta-Analysisen
dc.typejournalArticleen


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