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[Thrombolytic therapy for acute ischemic stroke. Experience of SITS (Safe Implementation of Thrombolysis in Stroke) register].

INTRODUCTION
Recently it has been demonstrated safety and efficacy of treatment with intravenous recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke in Europe, however there are differences in different European countries that may have variations in the response to treatment. In this study we reviewed the experience of thrombolytic therapy in Spain in a prospective observational register.


METHODS
The SITS-ISTR (Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register) is a register to evaluate the safety and efficacy of routine use of thrombolysis in acute ischemic stroke. This study analyzed the contribution of Spanish patients.


RESULTS
A total of 16,049 patients were included in the register between May 2002 and November 2007, of whom 1914 (11.9%) from 42 Spanish centers. Spanish patients had more history of diabetes, and less hypertension, atrial fibrillation, prior stroke, early signs of ischemia, and pretreatment with aspirin. In relation to the rest of countries, Spain had a higher percentage of functional independence at 3 months (OR 1.09; 95% CI: 1.02-1.15, p=0.01) although they have a slight increase in the number symptomatic hemorrhage (OR 1.29, 95% CI: 1.07-1.56, p=0.008), with no differences in the overall mortality (OR 0.99, 95% CI: 0.91-1.08, p=0.87).


CONCLUSIONS
In Spain, treatment with rt-PA for ischemic stroke is safe and effective when administered within the first 3 hours after symptom onset, and have a higher benefit than in the rest of the world.