Effectiveness and Safety of Intravenous Alteplase in Patients with Acute Ischemic Stroke: Results of a Single Centre Study

Objective: To evaluate effectiveness and safety of intravenous alteplase (tPA) for the treatment of acute ischemic stroke.

Materials and methods: In this prospective observational study, adult patients with ischemic stroke were treated with intravenous alteplase. We recorded baseline demographics and NIHS score was calculated at baseline, 2 hours, 24 hours and 7 days. Improvement was assessed by evaluating total NIH stroke score at different time points. Based on the neurological assessment, patients were categorised into three types; Unchanged (U), Improving (I) and Deteriorating (D). Blood pressure was closely monitored until 24 hours after infusion of alteplase. Both neurological assessment and blood pressure was monitored every 15 minutes for the first 2 hours after start of infusion then every 30 minutes for next 6 hours and hourly from the post infusion hour until 24 hours after infusion.

Results: Twenty six patients [male 16 (61.50%); female 10 (38.50)] between 34 to 86 years of age were enrolled in this study. Total NIHS score reduced from 10.77 (± 5.01) at pre-treatment to 4.04 (± 4.00) at 7 days. The improvement in NIHS score at two hours versus pre-treatment (p<0.001), at 24 hours versus 2 hours (p=0.002) and 7 days versus 24 hours (p<0.001) was statistically significant. Clinically no significant change was observed in the blood pressure of the patients till 24 hours after thrombolysis. At the end of 24 hours, 40% patients showed improved status and in 60% patients, status was unchanged.

Conclusion: Intravenous alteplase is effective and safe treatment approach for treatment of acute ischemic stroke. No major complications were observed in this study.