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Thrombolysis safely improves outcomes in young stroke patients

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Thrombolysis with intravenous alteplase is a safe and effective treatment for young patients with acute hemispheric ischemic stroke, Finnish researchers report.

Prior research has suggested that thrombolysis is beneficial in young stroke patients, but supporting data has come from studies lacking an untreated control group, Dr. Jukka Putaala and co-researchers, from Helsinki University Central Hospital, explain. In general, younger patients fare better than older patients, so it is possible that the incremental benefit of thrombolysis is modest.

The current study, reported in the June issue of Stroke, featured 48 consecutive patients between the ages of 16 to 49 years who had sustained an acute ischemic stroke and were treated with alteplase at the researchers’ center from 1994 to 2007. The subjects were matched by age, gender, and stroke severity to 96 controls not treated with alteplase. In addition, outcomes were also compared with those of 96 older alteplase-treated patients with strokes of similar severity.

Among young patients, those treated with alteplase were more likely to have a complete recovery (27% vs. 10%, p = 0.0101) and more likely to have a favorable 3-month outcome (a modified Rankin Scale score of 0 to 1) (40% vs. 22%, p = 0.025).

Younger and older alteplase-treated subjects had similar neurologic outcomes, although symptomatic intracerebral hemorrhage occurred in 3% of the older patients but none of the younger patients.

During 3-month follow-up, no deaths occurred in the younger alteplase-treated group compared with mortality rates of 2% and 7% in the age-matched and older controls, respectively.

Male gender and carotid artery dissection were both predictive of unfavorable outcomes in younger alteplase-treated subjects, the report indicates.

“Young adults with acute hemispheric stroke benefited from intravenous thrombolysis with good safety,” the authors conclude. Further research, they add, is needed to uncover additional prognostic factors in young adults undergoing thrombolysis and to determine the safety and efficacy of thrombolysis in children and adolescents with stroke.

Stroke 2009;40:2085-2091.