Intravenous thrombolysis for acute ischemic stroke in the 3- to 4·5-hour window--the Malabar experience.

Background: Intravenous thrombolysis for acute ischemic stroke with recombinant tissue plasminogen activator has been shown to be beneficial up to 4.5-hours of symptom onset.

Objective: The study aims to review our experience with thrombolysis with recombinant tissue plasminogen activator in the 3- to 4.5-hours window in acute ischemic stroke.

Methods: Prospective observational study of patients with acute ischemic stroke thombolysed between 3- and 4.5-hours after onset from July 2009 to October 2012 at a tertiary-care center in the Malabar region of South India. Methods: The dose of recombinant tissue plasminogen activator used was 50 mg in all patients. Inclusion and exclusion criteria were similar to European Co-operative Acute Stroke Study-3 criteria, with the exceptions that we did not use an age cutoff of 80 years and did not restrict thrombolysis for previous stroke with diabetes or elevated blood glucose levels. Methods: Good outcome was defined as a three-month modified Rankin Score of 2 or less. The chi-square test was used to compare the outcome among various sub-types of ischemic stroke. The age, blood glucose, National Institute of Health Stroke Scale Score, and time to thrombolysis were compared between groups with the nonparametric Mann-Whitney U-test.

Results: Thirty-one patients (median age 65 years, range 44-85, and median National Institute of Health Stroke Scale Score 10, range 5-22) were thrombolysed in the 3- to 4.5-hours window after stroke onset during the study period. In the first 24 h, 16 patients (52%) improved in National Institute of Health Stroke Scale Score by 4 or more points while three worsened by 4 or more points. At the three-month follow up, 15 patients (48%) were functionally independent (modified Rankin Score ≤ 2). None had symptomatic intracerebral hemorrhage. There was no significant difference in outcome between the various ischemic stroke sub-types. The baseline age, National Institute of Health Stroke Scale Score, blood glucose, and onset to treatment time did not differ significantly between the groups with good and poor outcome.

Conclusions: Our initial experience confirms that thrombolysis for ischemic stroke in the extended window is safe and beneficial.