Alteplase confers long-term survival benefit after stroke
medwireNews: Alteplase treatment in patients with acute ischaemic stroke is associated with a survival benefit among those who survive the acute phase, shows further analysis of IST-3.
“The results of this study are reassuring for clinicians concerned about the effect of alteplase on patient survival, and will help clinicians to inform patients and their relatives, and to discuss with them the early hazards and long-term benefits of treatment”, say the investigators.
The analysis involves 1946 participants from the UK and Scandinavia, for whom long-term survival data were obtainable. The 3-year mortality rates were 47% among patients randomly assigned to alteplase and 50% in the standard care group, which was not a significant difference.
However, differences emerged when Eivind Berge (Oslo University Hospital, Norway) and colleagues considered short- and long-term mortality separately, they report in The Lancet Neurology.
During the first 7 days after treatment, there was an increased mortality rate in the alteplase group versus the control group, at 10% versus 7%, equating to a significant hazard ratio (HR) of 1.52. The excess deaths in the alteplase group were due mainly to intracerebral haemorrhage or expansion of the original infarct.
But between 8 days and 3 years, the mortality rates were 41% versus 47% in the alteplase and control groups, respectively, giving an HR of 0.78 in favour of alteplase. The long-term survival benefit was consistent across subgroups of age, National Institutes of Health Stroke Scale score and time to alteplase treatment.
In an accompanying commentary, Rüdiger Seitz (Landschaftsverband Rheinland-Klinikum Düsseldorf, Germany) describes the long-term survival benefit as “noteworthy”.
He says: “Since this difference was not due to patients’ age, stroke severity at onset, or time to treatment, and standard treatment ought to be the same in both patient groups, this difference is likely to result from an improved functional outcome after alteplase treatment.”
However, Seitz notes that the early increased mortality risk associated with alteplase extended beyond the acute phase to around 4 months.
“Given that standard medical care was the same in those given and not given alteplase, and that their age and severity of stroke at onset were the same, the causes for the excessive rate of deaths in those given alteplase are unclear”, he says, calling for further investigation.
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