NASHVILLE—Tissue plasminogen activator (t-PA) appears to be safe in the treatment of stroke detected when people wake up in the morning, according to a multicenter, prospective study presented at
the 2015 International Stroke Conference.
A significant number of ischemic strokes is noticed
upon awakening. Patients with this type of stroke are
not generally considered candidates for IV t-PA because the treatment must be delivered within three
hours of stroke onset, and the time of stroke onset is
unknown for these patients.
Andrew D. Barreto, MD, Assistant Professor in the
Department of Neurology at the University of Tex-
as Health Science Center in Houston, and colleagues
conducted a multicenter, single-arm, prospective, open-
label study to evaluate the safety of IV thrombolysis in
wake-up stroke.
Patients enrolled in the study had a broad range
of stroke severities and levels of disability. Study
participants were between the ages of 18 and 80,
had an NIH Stroke Scale (NIHSS) score of 25 or
lower, and were selected solely according to the appearance of noncontrast CT. A standard dose (0.9
mg/kg) of IV t-PA had to be started three hours
or fewer after the patient awakened (average time
2. 6 hours).
The primary safety outcome was symptomatic intracerebral hemorrhage. Other end points included
Patients With Wake-Up Stroke
May Be Candidates for t-PA
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