Why not Intravenous Thrombolysis in Patients with Recurrent Stroke within 3 Months?
Wu Chuanjie1, Wu Di2, Chen Jian3, Li Chuanhui3, Ji Xunming3,*
1Department of neurology, Xuanwu Hospital Capital Medical University, Beijing, China 2China-America Institute of Neuroscience, Xuanwu Hospital Capital Medical University, Beijing, China 3Department of neurosurgery, Xuanwu Hospital Capital Medical University, Beijing, China
Acute ischemic stroke continues to be a very severe disorder that has significant impact on human health. Its treatment options are limited and alteplase remains the only American Food and Drug Administration-approved drug for patients with acute ischemic stroke. Furthermore, intravenous thrombolysis remains substantially underutilized, because it has rigorous indications and contraindications. Most patients simply do not meet these criteria and cannot receive thrombolytic treatment. Guidelines in many countries currently include a history of stroke within months as one of the exclusion criteria for intravenous thrombolysis. Although this is based on previous data, it lacks strong evidentiary support. Several recent studies suggested that intravenous thrombolysis may be beneficial for this patient population. We reviewed relevant publications of intravenous thrombolysis or repeated intravenous thrombolysis in patients with a history of stroke in the past 3 months. We found that intravenous thrombolysis in these patients is not as hazardous as previously believed. Among patients with relatively small infarctions and a good prognosis, intravenous thrombolysis may be a good treatment option. We hope that more research will be carried out on this topic to reexamine the criteria for intravenous thrombolysis to allow more patients to benefit from treatment.
1.6% by SITS definition; 6.2% by ECASS II definition; No statistical difference compared with control group
48.7% mRS≤2; No statistical difference compared with control group
Heldner et al. 
Alhazzaa et al. 
ranging from 6 days to 10 weeks
Yoo et al. 
6 and 90
420 and 70
both mRS were 0
Cappellari et al. 
2, 2, 11
35, 64, 148
all mRS were 0
Table 1 Key-studies with intravenous thrombolysis for recurrent ischemic stroke.
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