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Sablot D, Leibinger F, Dutray A, Van Damme L, Nguyen Them L, Farouil G, Jebali C, Arquizan C, Ibanez-Julia MJ, Laverdure A, Allou T, Chaabane W, Fadat B, Olivier N, Smadja P, Tardieu M, Lachcar M, Mas J, Ousji A, Jurici S, Mourand I, Ferraro A, Dumitrana A, Bensalah ZM, Damon F, Tincau OA, Valverde D, Mekue-Fotso V, Bonafe A, Ortega L, Gaillard N. Is off-label thrombolysis safe and effective in a real-life primary stroke center? A retrospective analysis of data from a 5-year prospective database. Rev Neurol (Paris) 2022; 178:1079-1089. [PMID: 36336491 DOI: 10.1016/j.neurol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/21/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) use for acute ischemic stroke (AIS) varies among countries, partly due to guidelines and product labeling changes. The study aim was to identify the characteristics of patients with AIS treated with off-label IVT and to determine its safety when performed in a primary stroke center (PSC). METHODS This observational, single-center study included all consecutive patients admitted to Perpignan PSC for AIS and treated with IVT and patients transferred for EVT, between January 1, 2015 and December 31, 2019. Data of patients treated with IVT according to ("in-label group") or outside ("off-label") the initial guidelines and manufacturer's product specification were compared. Safety was assessed using symptomatic intracerebral hemorrhage (SIH) as the main adverse event. RESULTS Among the 892 patients in the database (834 screened by MRI, 93.5%), 746 were treated by IVT: 185 (24.8%) "in-label" and 561 (75.2%) "off-label". In the "off-label" group, 316 (42.4% of the cohort) had a single criterion for "off-label" use, 197 (26.4%) had two, and 48 (6.4%) had three or more criteria, without any difference in IVT safety pattern among them. SIH rates were comparable between the "off-label" and "in-label" groups (2.7% vs. 1.1%, P=0.21); early neurological deterioration and systematic adverse event due to IVT treatment were similar in the 2 groups. "Off-label" patients had higher in-hospital (8.7% vs. 3.8%, P=0.05) and 3-month mortality rates (12.1% vs 5.4%, P<0.01), but this is explained by confounding factors as they were older (76 vs 67 years, P<0.0001) and more dependent (median modified Rankin scale score 0.4 vs 0.1, P<0.0001) at admission. CONCLUSIONS "Off-label" thrombolysis for AIS seems to be safe and effective in the routine setting of a primary stroke center.
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Affiliation(s)
- D Sablot
- Neurology Department, Perpignan, France; Regional Health agency of Occitanie, Montpellier, France.
| | | | - A Dutray
- Neurology Department, Perpignan, France
| | | | | | - G Farouil
- Radiology Department, Perpignan, France
| | - C Jebali
- Emergency Department, Perpignan, France
| | - C Arquizan
- Neurology Department, Montpellier, France
| | | | | | - T Allou
- Neurology Department, Perpignan, France
| | | | - B Fadat
- Neurology Department, Perpignan, France
| | - N Olivier
- Neurology Department, Perpignan, France
| | - P Smadja
- Radiology Department, Perpignan, France
| | - M Tardieu
- Radiology Department, Perpignan, France
| | - M Lachcar
- Emergency Department, Perpignan, France
| | - J Mas
- Neurology Department, Perpignan, France
| | - A Ousji
- Emergency Department, Perpignan, France
| | - S Jurici
- Neurology Department, Perpignan, France
| | - I Mourand
- Neurology Department, Montpellier, France
| | - A Ferraro
- Neurology Department, Perpignan, France
| | | | | | - F Damon
- Neurology Department, Perpignan, France; Emergency Department, Perpignan, France
| | | | | | | | - A Bonafe
- Radiology Department, Perpignan, France; Neuroradiology Department, Montpellier, France
| | - L Ortega
- Emergency Department, Perpignan, France
| | - N Gaillard
- Neurology Department, Perpignan, France; Neurology Department, Montpellier, France
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