Thrombolytic Therapy May Be Safe For Treating Wake-Up Stroke

Recombinant tissue plasminogen activator (rtPA)—the only medication available for the acute treatment strokes—is safe for treating wake-up stroke occurring within 3 hours of awakening, according to new evidence.

About 25% of strokes are noticed upon waking up. These patients are not typically eligible for rtPA treatment, because their symptom onset is unknown, and treatment must be administered within 4.5 hours of onset to be effective.

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To investigate whether rtPA is safe for this patient population, the researchers enrolled 40 patients aged 18 to 80 years who experienced a wake-up stroke with a score of 25 or less on the National Institutes of Health Stroke Scale (NIHSS) and were treated at 5 stroke centers.

The researchers administered a standard dose (0.9 mg/kg) of intravenous rtPA within 3 hours after the patient woke up and supervised for symptomatic or asymptomatic intracerebral hemorrhage, clinical improvement in NIHSS, and 90-day modified Rankin Scale score, which measures degree of disability after stroke.

No patients had experienced an intracerebral hemorrhage. And after 90 days, 53% of patients achieved excellent recovery according to the modified Rankin Scale.

“Intravenous thrombolysis was safe in this prospective [wake-up stroke] study of patients selected by noncontrast CT,” the researchers concluded. “A randomized effectiveness trial appears feasible using a similar, pragmatic design.”

—Amanda Balbi

Reference:

Barreto AD, Fanale CV, Alexandrov AV, et al; for the Wake-Up Stroke Investigators. Prospective, open-label safety study of intravenous recombinant tissue plasminogen activator in wake-up stroke. Ann Neurol. 2016;80(2):211-218. doi:10.1002/ana.24700.