Three articles in this issue of JAMAaddress
patient outcomes after thrombolytic therapy for stroke. First, Heuschmann
and colleagues Article reviewed data on patients receiving
tissue plasminogen activator (tPA) to identify predictors of in-hospital death.
Patient characteristics predictive of mortality were older age and decreased
level of consciousness. In-hospital mortality risk was inversely associated
with hospital experience administering tPA. In the second article, Saposnik
and colleagues Article report an analysis of data from
a prospective study of patients who received alteplase therapy to identify
factors predictive of lack of improvement at 24 hours. They found that an
elevated baseline glucose level, cortical involvement, and increasing time
to thrombolytic therapy were associated with a lack of improvement at 24 hours,
which was an independent predictor of poor outcome and death at 3 months.
In the third article, Lindsberg and colleagues Articledescribe
outcomes for 50 patients with basilar artery occlusion who received intravenous
thrombolytic therapy. They found these patients had comparable survival, recanalization,
and functional outcomes as previously reported for patients treated with an
endovascular approach. In an editorial, Caplan Article discusses
how existing guidelines for stroke diagnosis and treatment require updating
to ensure timely and effective care.