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Fourteen Percent of Ischemic Strokes Are Wake-Up Strokes

At least 35.9 percent of wake-up strokes may have been eligible for thrombolysis

TUESDAY, May 10 (HealthDay News) -- Wake-up strokes constitute a substantial percentage of all strokes and cannot be easily distinguished from non-wake-up strokes, according to a study published in the May 10 issue of Neurology.

Jason Mackey, M.D., from the University of Cincinnati, and colleagues compared the proportion and event rate of wake-up strokes (patients who awoke with stroke) with non-wake-up strokes (patients awake at time of onset) among 1,854 patients who presented to the emergency department with ischemic strokes, aged 18 years or above. International Classification of Diseases-9 codes 430 to 436 were used to identify strokes, which were confirmed by study physician review. The baseline characteristics, discharge modified Rankin Scale scores, and 90-day mortality were evaluated.

The investigators found that 14.3 percent of the strokes were wake-up strokes, with an adjusted wake-up stroke event rate of 26.0 per 100,000 population. If time was not a factor, at least 35.9 percent of wake-up strokes would have been eligible for thrombolysis. With regard to clinical features and outcomes, there were no differences between wake-up strokes and all other strokes except for minor age and baseline retrospective National Institutes of Health Stroke Scale score differences.

"Wake-up strokes constitute a significant percentage of ischemic strokes and are ineligible for thrombolytic therapy due to the current time-based restrictions, which is unfortunate because it is likely that some of these events occurred immediately prior to awakening," the authors write.

Several authors disclosed financial relationships with the pharmaceutical industry.

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