For patients with ischemic stroke, intravenous thrombolysis of alteplase (rt-PA) has been a focus of debate. The third International Stroke Study (IST-3) published at the European Stroke Conference in 2012 confirmed the efficacy of thrombolysis within 3 hours and suggested the possibility of a 6h thrombolysis time window. Recently, the study's 3-year follow-up results showed that the use of rt-PA thrombolysis within 6 hours after ischemic stroke, at 3 years can be slightly, not significantly reduce the risk of death; but for the survival of patients after the acute phase, Rt-PA treatment can significantly increase the patient's long-term survival rate. (Lancet Neur01. July 19 online version)
The IST-3 study included 3035 patients in 12 countries and 156 hospitals, 53% of whom were over 80 years of age. During the 6 h after ischemic stroke, patients in the rt-PA group received 0.9 mg / kg intravenous rt-PA thrombolytic therapy and standard management, while the control group received only standard management. Thrombolysis time window, 3h to receive thrombolytic therapy accounted for 28%, 3-4.5h accounted for 38%, 4.5-6h accounted for 33%.
The results showed no significant difference in the primary end points between the two groups; however, significant differences were observed between the two groups using OHS score 0-1 criteria (indicating excellent prognosis) in assessing the patient's prognosis. It is noteworthy that, compared with the control group, rt-PA group of patients with symptomatic bleeding more than 7 times the possibility of follow-up after 6 months, the two groups of mortality was no significant difference.Therefore, the researchers believe that, although rt-PA thrombolysis may bring early harm, but for the improvement of functional prognosis is still valuable.
Thereafter, 64% of patients were included in a 3-year follow-up analysis. Three years later, 453 (47%) patients died in the rt-PA group and 494 (50%) patients died in the control group. The risk of death was significantly higher in the rt-PA group than in the control group (HR = 1.52), and the risk of death in the rt-PA group was significantly lower at 8 days to 3 years (HR = O .78). In the subgroup analysis, thrombolysis did not affect the effect of rt-PA at 3 h and 3 to 6 h. In addition, the patient age (at 80 years of age) and NIHSS score (bound by 10) did not show subgroup differences.