To measure how often and why alteplase intravenous thrombolysis (IVT) was interrupted or stopped at a high-volume German stroke center, and describe the clinical course and complications in affected patients.
Approach:
Design and population: Retrospective cohort of 1,504 patients treated with alteplase for suspected acute ischemic stroke from January 2018 through March 2024.
Assessment: Researchers identified IVT interruptions or premature terminations, documented reasons and administered dose, and assessed complications and clinical outcomes.
Key Findings:
IVT was discontinued in 23 of 1,504 patients (1.5%): 5 (0.3%) had treatment interrupted but later received the full dose, and 18 (1.2%) had treatment terminated early and received a reduced dose.
The leading reported reasons included extracranial bleeding, reassessment of acute cerebral imaging, and neurological deterioration; the supplied context does not provide their individual counts.
Eleven of the 23 patients (47.8%) underwent endovascular thrombectomy.
Compared with patients who completed IVT, those with discontinuation underwent thrombectomy more often (47.8% vs. 27.9%; p = 0.035). Other reported baseline and treatment-time comparisons were not statistically significant.
Interpretation:
In this single-center cohort, interruption or premature termination of alteplase IVT was uncommon. The study also reports that thrombectomy was more frequent among patients whose IVT was discontinued.
Limitations:
The study was retrospective and conducted at a single center.
The supplied context ends before the full results, including detailed reasons, complication rates, and outcomes, are reported.
Conclusion:
Alteplase IVT was interrupted or terminated in a small proportion of patients. These findings underscore the need for further research to clarify the reasons for discontinuation and its clinical consequences.
by Matthias Krämer, Alexander Sekita, Matthias C. Borutta, Ludwig Singer, Tobias Engelhorn, Bernd Kallmünzer, Stefan Schwab, Stefan T. Gerner, Kosmas Macha
