[Thrombolysis in apoplexy. How big is the target group and how many benefit?]

Abstract

Introduction: At present it is possible to dissolve cerebral blood clots with thrombolysis. This is a standard treatment in the USA and Canada for early onset ischaemic strokes within three hours of the stroke. Acceptance of thrombolysis is based on a single clinical trial. However, three other clinical trials have cast doubt on the benefit of the treatment and it has not yet been approved in Denmark and other countries. We sought to investigate the possible impact of thrombolysis in an unselected Danish stroke population.

Material and methods: This prospective study examined 502 unselected patients with acute stroke admitted over a period of eight months. The most important exclusion criteria from the North American trial with thrombolysis for acute ischaemic stroke were applied on the Danish cohort. The number of patients who might benefit from thrombolytic therapy was estimated from the North American trial, which reported a 32% relative increase in patients who would fully recover.

Results: Thirty-nine (8%) would be eligible for thrombolytic therapy. Thirteen patients (3%) would die, irrespective of treatment, and 11 patients (2%) would fully recover spontaneously. Three patients (0.6%) would benefit from thrombolytic therapy. In the ideal situation--all patients admitted in due time--11 patients (2.2%) would have benefited.

Conclusion: Our study shows that few stroke patients would benefit from thrombolysis. The result is very well in line with the clinical experiences reported from the USA. Introduction of thrombolysis in Denmark to benefit the few would require extensive reorganisation of stroke care.