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Stroke

Halifax, Nova Scotia

To the Editor:

Stroke is a leading cause of death and disability among adults in Canada. While thrombolytic therapy has been used for the treatment of acute ischemic stroke, its use is controversial. We reviewed our experience of thrombolytic treatment for acute ischemic stroke at the QEII HSC using a protocol developed by the Canadian Stroke Consortium.¹

We conducted a retrospective case series study involving 12 patients (eight who received thrombolytic therapy and four who did not (patients with ischemic stroke not candidates for thrombolysis)). They were admitted to the ICU following acute ischemic stroke between December 1997 and January 1999. Chart and computed tomographic scans were reviewed and data collected and analyzed. Seven out of eight patients in the thrombolytic group received tPA and one received streptokinase. Two patients that received tPA had an intracranial hemorrhage and both died. In total, five patients died in the thrombolytic group and all patients that did not receive thrombolytic treatment died. Patients in the control group tended to stay longer in the ICU, received more laboratory tests, but fewer CT scans compared to thrombolytic patients. We conclude that, in this small series, administration of thrombolytic drugs following current guidelines for therapy for acute ischemic stroke was associated with a high mortality rate which is, however, in-keeping with the mortality rate in reports from large scale clinical trials.² Good functional recovery occurred in 30% of patients. Our results suggest that use of the guidelines for thrombolytic treatment of acute ischemic stroke will produce results similar to that found in large scale clinical trials and serves to validate the original findings.

References

1 Norris JW, Buchan A, Hachinski V, et al. Canadian guidelines for intravenous thrombolytic treatment in acute stroke. Can J Neurol Sci 1998; 25: 257–9.[Medline]

2 Wardlaw JM, Warlow CP, Counsell C. Systematic review of evidence on thrombolytic therapy for acute ischemic stroke. Lancet 1997; 350: 607–14.[Medline]

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