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Time of day affects recanalization success of thrombolysis for stroke

מתוך medicontext.co.il
SAN ANTONIO (Reuters Health) – Recanalization rates with tPA for acute cardioembolic stroke are significantly higher between noon and midnight than between midnight and noon, attendees of the American Stroke Association's 27th International Stroke Conference heard on Friday.

Spanish researchers, led by Dr. Carlos A. Molina, of the Hospital Vall d'Hebron in Barcelona, divided 47 patients with acute embolic stroke of the middle cerebral artery into two groups. The 21 patients in group A had strokes that occurred between midnight and noon. Group B's 26 patients had strokes that occurred between noon and midnight.

All patients received intravenous tPA within less than 3 hours of the onset of symptoms and were assessed at 6, 12, and 24 hours with transcranial Doppler monitoring. Infarct volume was measured between day 5 and day 7 post-stroke and 3-month outcome was documented.

During tPA infusion, recanalization took place in 53% of patients in the post-noon treatment group compared with 27% of patients in the pre-noon group. Six hours after thrombolysis, recanalization had been achieved in 84% of patients in group B compared with 45% of patients in group A.

Infarct size and damage was significantly lower in group B, those whose strokes occurred between noon and midnight, Dr. Molina reported. Long-term outcome was also better in this group compared with those whose strokes occurred between midnight and noon. The Spanish researchers found that 72% of patients in the post-noon group were independent 3 months after stroke compared with 45% in the pre-noon group.

As has been shown in MI, Dr. Molina said that the difference in outcome between the two groups of stroke patients could be explained by differences in endogenous and exogenous fibrinolytic activity throughout the course of the day.

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