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Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study
BACKGROUND: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. METHODS: From the multicenter database ThRombolysis for...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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SAGE Publications
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683723/ https://www.ncbi.nlm.nih.gov/pubmed/37421135 http://dx.doi.org/10.1177/23969873231185895 |
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author | Baumgartner, Philipp Kook, Lucas Altersberger, Valerian L Gensicke, Henrik Ardila-Jurado, Elena Kägi, Georg Salerno, Alexander Michel, Patrik Gopisingh, Kiran M Nederkoorn, Paul J Scheitz, Jan F Nolte, Christian H Heldner, Mirjam R Arnold, Marcel Cordonnier, Charlotte Della Schiava, Lucie Hametner, Christian Ringleb, Peter A. Leker, Ronen R Jubran, Hamza Luft, Andreas R Engelter, Stefan T Wegener, Susanne |
author_facet | Baumgartner, Philipp Kook, Lucas Altersberger, Valerian L Gensicke, Henrik Ardila-Jurado, Elena Kägi, Georg Salerno, Alexander Michel, Patrik Gopisingh, Kiran M Nederkoorn, Paul J Scheitz, Jan F Nolte, Christian H Heldner, Mirjam R Arnold, Marcel Cordonnier, Charlotte Della Schiava, Lucie Hametner, Christian Ringleb, Peter A. Leker, Ronen R Jubran, Hamza Luft, Andreas R Engelter, Stefan T Wegener, Susanne |
author_sort | Baumgartner, Philipp |
collection | PubMed |
description | BACKGROUND: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. METHODS: From the multicenter database ThRombolysis for Ischemic Stroke Patients (TRISP), we retrospectively analyzed visual acuity (VA) at baseline and within 3 months in IVT and non-IVT treated RAO patients. Primary outcome was difference of VA between baseline and follow up (∆VA). Secondary outcomes were rates of visual recovery (defined as improvement of VA ⩾ 0.3 logMAR), and safety (symptomatic intracranial hemorrhage (sICH) according to ECASS II criteria, asymptomatic intracranial hemorrhage (ICH) and major extracranial bleeding). Statistical analysis was performed using parametric tests and a linear regression model adjusted for age, sex and baseline VA. RESULTS: We screened 200 patients with acute RAO and included 47 IVT and 34 non-IVT patients with complete information about recovery of vision. Visual Acuity at follow up significantly improved compared to baseline in IVT patients (∆VA 0.5 ± 0.8, p < 0.001) and non-IVT patients (∆VA 0.40 ± 1.1, p < 0.05). No significant differences in ∆VA and visual recovery rate were found between groups at follow up. Two asymptomatic ICH (4%) and one (2%) major extracranial bleeding (intraocular bleeding) occurred in the IVT group, while no bleeding events were reported in the non-IVT group. CONCLUSION: Our study provides real-life data from the largest cohort of IVT treated RAO patients published so far. While there is no evidence for superiority of IVT compared to conservative treatment, bleeding rates were low. A randomized controlled trial and standardized outcome assessments in RAO patients are justified to assess the net benefit of IVT in RAO. |
format | Online Article Text |
id | pubmed-10683723 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-106837232023-11-30 Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study Baumgartner, Philipp Kook, Lucas Altersberger, Valerian L Gensicke, Henrik Ardila-Jurado, Elena Kägi, Georg Salerno, Alexander Michel, Patrik Gopisingh, Kiran M Nederkoorn, Paul J Scheitz, Jan F Nolte, Christian H Heldner, Mirjam R Arnold, Marcel Cordonnier, Charlotte Della Schiava, Lucie Hametner, Christian Ringleb, Peter A. Leker, Ronen R Jubran, Hamza Luft, Andreas R Engelter, Stefan T Wegener, Susanne Eur Stroke J Original Research Articles BACKGROUND: Retinal artery occlusion (RAO) may lead to irreversible blindness. For acute RAO, intravenous thrombolysis (IVT) can be considered as treatment. However, due to the rarity of RAO, data about IVT safety and effectiveness is limited. METHODS: From the multicenter database ThRombolysis for Ischemic Stroke Patients (TRISP), we retrospectively analyzed visual acuity (VA) at baseline and within 3 months in IVT and non-IVT treated RAO patients. Primary outcome was difference of VA between baseline and follow up (∆VA). Secondary outcomes were rates of visual recovery (defined as improvement of VA ⩾ 0.3 logMAR), and safety (symptomatic intracranial hemorrhage (sICH) according to ECASS II criteria, asymptomatic intracranial hemorrhage (ICH) and major extracranial bleeding). Statistical analysis was performed using parametric tests and a linear regression model adjusted for age, sex and baseline VA. RESULTS: We screened 200 patients with acute RAO and included 47 IVT and 34 non-IVT patients with complete information about recovery of vision. Visual Acuity at follow up significantly improved compared to baseline in IVT patients (∆VA 0.5 ± 0.8, p < 0.001) and non-IVT patients (∆VA 0.40 ± 1.1, p < 0.05). No significant differences in ∆VA and visual recovery rate were found between groups at follow up. Two asymptomatic ICH (4%) and one (2%) major extracranial bleeding (intraocular bleeding) occurred in the IVT group, while no bleeding events were reported in the non-IVT group. CONCLUSION: Our study provides real-life data from the largest cohort of IVT treated RAO patients published so far. While there is no evidence for superiority of IVT compared to conservative treatment, bleeding rates were low. A randomized controlled trial and standardized outcome assessments in RAO patients are justified to assess the net benefit of IVT in RAO. SAGE Publications 2023-07-07 2023-12 /pmc/articles/PMC10683723/ /pubmed/37421135 http://dx.doi.org/10.1177/23969873231185895 Text en © European Stroke Organisation 2023 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Research Articles Baumgartner, Philipp Kook, Lucas Altersberger, Valerian L Gensicke, Henrik Ardila-Jurado, Elena Kägi, Georg Salerno, Alexander Michel, Patrik Gopisingh, Kiran M Nederkoorn, Paul J Scheitz, Jan F Nolte, Christian H Heldner, Mirjam R Arnold, Marcel Cordonnier, Charlotte Della Schiava, Lucie Hametner, Christian Ringleb, Peter A. Leker, Ronen R Jubran, Hamza Luft, Andreas R Engelter, Stefan T Wegener, Susanne Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study |
title | Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study |
title_full | Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study |
title_fullStr | Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study |
title_full_unstemmed | Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study |
title_short | Safety and effectiveness of IV Thrombolysis in retinal artery occlusion: A multicenter retrospective cohort study |
title_sort | safety and effectiveness of iv thrombolysis in retinal artery occlusion: a multicenter retrospective cohort study |
topic | Original Research Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10683723/ https://www.ncbi.nlm.nih.gov/pubmed/37421135 http://dx.doi.org/10.1177/23969873231185895 |
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