Abstract WP80: Impact of Lipoic Acid Use on Stroke Outcome After Thrombolysis in Patients With Diabetic Polyneuropathy

Abstract

Background: Alpha-lipoic acid (aLA) is a strong antioxidant commonly used for treatment of diabetic polyneuropathy (DPNP). Previously, we demonstrated the neurorestorative effects of aLA after cerebral ischemia in rats. However, its effects on stroke patients remain unknown. This study investigated whether patients treated with aLA for acute ischemic stroke (AIS) after reperfusion therapy have a better functional outcome than aLA-naïve patients. Methods: In a prospective observational cohort study of 172 patients with DPNP and AIS treated with tissue plasminogen activator (tPA), we investigated the relationship between aLA use and functional outcome at 3 months and 1 year, the occurrence of hemorrhagic transformation (HT), early neurological deterioration (END), and early clinical improvement (ECI). The functional outcomes of patients were categorized as favorable (modified Rankin Scale [mRS] score 0-2) or unfavorable (mRS score 3-6). We defined END as an increase of ≥1 point in motor power or an increase of ≥2 points in the total National Institute of Health Stroke Scale (NIHSS) score and ECI as a decrease of ≥4 points in NIHSS score within 7 days. Ischemic stroke subtypes were defined according to the TOAST classification. Results: Of the 172 AIS with DPNP patients included, 47 (27.3%) used aLA for DPNP. In the entire cohort, those treated with aLA had a significantly higher rate of a favorable outcome at 3 months (55.3 vs. 33.6%, p < 0.01) and 1 year (57.4 vs. 34.4%, p < 0.01) compared with their counterparts. The risks of END and HT were significantly lower and the percentages of ECI were significantly higher in those treated with aLA. In the multivariable analysis, aLA use was associated with favorable outcome at 3 months (OR = 2.13, 95% CI = 1.01-4.51, p = 0.048) and 1 year (OR = 2.26, 95% CI = 1.06-4.84, p = 0.036). Age, HT, and increasing NIHSS scores were negative predictors of favorable outcome. Conclusions: aLA use for AIS with DPNP patients treated with tPA is associated with favorable outcome. These results indicate that aLA could be a useful intervention for the treatment of AIS after reperfusion therapy.