Typically, clot-busting drugs, called thrombolytics, are injected through a vein (intravenously). This analysis reviewed studies of intra-arterial thrombolytics (IAT), which is delivering clot busters via an artery.
Researchers reviewed of 27 studies from 1988 to 2002 comprising 852 stroke patients who received IAT and 100 who did not receive thombolytics. They found that IAT led to favorable outcomes in 41.5 percent of patients, compared to 23 percent patients who didn't receive thrombolytics. The death rate was also lower among patients given IAT 27.2 percent vs. 40 percent. A subset of patients who received both intra-arterial and intravenous thrombolytics did even better, as 53.6 percent had favorable outcomes.
For the purposes of the study, the researchers defined a favorable outcome as the absence of significant disability. In most of the studies, neurologic outcomes were evaluated 90 days after the stroke.
Bleeding in the brain occurred more often in the IAT patients than the controls 9.5 percent vs. 3 percent. However, the increased bleeding did not translate into increased death rate.
The higher rate of bleeding may be a reflection of stroke severity because bleeding tends to occur in patients with more severe strokes, researchers say.
"There appears to be a net benefit from intra-arterial thrombolytic therapy," says Mark J. Alberts, M.D., professor of neurology and director of the stroke program at Northwestern University in Chicago. "However, the benefit comes at a cost in the form of an increased rate of symptomatic intracerebral hemorrhage, which needs to b
Contact: Carole Bullock
American Heart Association