Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Tanaka, Kõji; Matsumoto, Shoji; Furuta, Konosuke; Yamada, Takeshi; Nagano, Sukehisa; Takase, Kei‐ichiro; Yamasaki, Ryo; Kira, Jun Ichi

doi:10.1007/s11239-019-02015-4

Cited by 19 publications

(13 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Consistent with previous studies, [16][17][18][19][20][21][22] the present study showed that atrial fibrillation, the NIHSS score and the glucose level on admission were independent predictors of postthrombolysis ICH. However, these risk factors, identified using the conventional method with ORs, accounted for only a proportion of the stroke patients who presented with ICH after intravenous thrombolysis, rather than determining a probabilistic estimate for clinicians.…”

Section: Discussionsupporting

confidence: 92%

<p>Risk Factors and a Nomogram for Predicting Intracranial Hemorrhage in Stroke Patients Undergoing Thrombolysis</p>

Yin¹,

Niu²,

Liang³

et al. 2020

NDT

View full text Add to dashboard Cite

Identifying stroke patients at risk of postthrombolysis intracranial hemorrhage (ICH) in the clinical setting is essential. We aimed to develop and evaluate a nomogram for predicting the probability of ICH in acute ischemic stroke patients undergoing thrombolysis. Patients and Methods: A retrospective observational study was conducted using data from 345 patients at a single center. The patients were randomly dichotomized into training (2/3; n=233) and validation (1/3; n=112) sets. A prediction model was developed by using a multivariable logistic regression analysis. Results: The nomogram comprised three variables: the presence of atrial fibrillation (odds ratio [OR]: 4.92, 95% confidence interval [CI]: 2.09-11.57), the National Institutes of Health Stroke Scale (NIHSS) score (OR: 1.11, 95% CI: 1.04-1.18) and the glucose level on admission (OR: 1.27, 95% CI: 1.08-1.50). The areas under the receiver operating characteristic curve of the nomogram for the training and validation sets were 0.828 (0.753-0.903) and 0.801 (0.690-0.911), respectively. The Hosmer-Lemeshow test revealed good calibration in both the training and validation sets (P = 0.509 and P = 0.342, respectively). The calibration plot also demonstrated good agreement. A decision curve analysis demonstrated that the nomogram was clinically useful. Conclusion: We developed an easy-to-use nomogram model to predict ICH, and the nomogram may provide risk assessments for subsequent treatment in stroke patients undergoing thrombolysis.

show abstract

Section: Discussionsupporting

confidence: 92%

<p>Risk Factors and a Nomogram for Predicting Intracranial Hemorrhage in Stroke Patients Undergoing Thrombolysis</p>

Yin¹,

Niu²,

Liang³

et al. 2020

NDT

View full text Add to dashboard Cite

show abstract

“…Predictive factors at presentation for END are even more numerous, including, but not limited to, higher NIHSS, older age, lower ASPECTS, LVO, hyperglycemia, or history of diabetes mellitus [ 8 , 11 , 12 , 14 , 15 ]. In this study, older patients, those with history of tobacco use, and history of hyperlipidemia were predictive of END along with the presence of an untreated LVO.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the abundant contributing factors to END, there does appear to be a temporal relationship dictating when the majority of deteriorating events occur. Median time worsening from both hemorrhagic and nonhemorrhagic causes have been shown to be between 7 and 12 h [ 15 , 16 ]. Patients with relatively milder deficits, specifically NIHSS < 10, have sICH rates of 3% compared to 17% for those with NIHSS > 20 [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA

et al. 2021

View full text Add to dashboard Cite

Background Acute ischemic stroke (AIS) is a major contributor toward healthcare-associated costs and services. Symptomatic intracranial hemorrhage (sICH) and early neurologic decline (END), defined as a National Health Institute Stroke Scale score decline of ≥ 4 within 24 h (with or without sICH), remain major concerns when administering intravenous tissue plasminogen activator (IV tPA) despite improved functional neurologic outcomes with its use. Given these risks, current guidelines recommend comprehensive stroke care (most often in an intensive care unit setting) for 24 h posttreatment. However, a number of patients may remain stable after IV tPA and thus not require such intensive resources. We sought to determine causes of END, along with timing and predictors of both sICH and END, to identify patients at lower risk of neurological deterioration and those suitable for earlier transition to a lower level of care. Methods This present study analyzed patients with AIS that presented within 4.5 h of being last seen well and received IV tPA. Baseline demographic, clinical, and radiographic findings were collected. Outcomes included END from any cause, parenchymal hemorrhage (PH1 or PH2), sICH, and mortality at 90 days. Results A total of 1238 patients with AIS without acute treatment of large vessel occlusion received IV tPA. 9.4% (116) had presence of any degree of ICH on noncontrast computed tomography head and 7.4% (91) experienced associated END. 2.7% (33) of patients experienced sICH, while 6.7% (83) experienced asymptomatic ICH. Of the patients with END, 63.7% did not have ICH. Predictive factors at presentation for END included an older age (72.6 ± 16.1 vs. 69.1 ± 14.8, p = 0.03), history of tobacco use (odds ratio [OR] 2.1 [1.1–4.3], p = 0.04), and hyperlipidemia (OR 1.7 [1.1–2.8], p = 0.02), along with the presence of an untreated large vessel occlusion (OR 2.1 [1.4–3.1], p = 0.02). Most END occurred within a mean time of 242 ± 251 min (4 ± 4 h). Because of the small proportion of patients suffering from sICH (33), predictors could not be determined; however, for patients with any ICH, predictive factors included an older age (74.6 ± 12.4 vs. 68.8 ± 15.1, p = 0.001), higher baseline National Health Institute Stroke Scale score (14.6 ± 7.3 vs. 10.8 ± 7.9, p = 0.002), and higher baseline glucose levels (155.1 ± 87.5 vs. 140.4 ± 70.5, p = 0.04). Conclusions In this study, only a small proportion suffered from either sICH and/or END, typically within 12 h of tPA administration. These findings may support earlier deescalation of higher acuity monitoring in clinically stable post-IV tPA patients without large vessel occlusion.

show abstract

“…With the continuous development of social economy and medical industry, more and more people have conducted indepth research on the prediction of END after intravenous thrombolysis. Tanaka et al investigated differences in predictors of END due to hemorrhagic and ischemic injury [1]. Wu et al evaluated the safety and efficacy of early low dose casein therapy for early end patients within the first 24 hours after IVT [2].…”

Section: Related Workmentioning

confidence: 99%

Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis

Jiang

Zuo

Chen

et al. 2022

Emergency Medicine International

View full text Add to dashboard Cite

With the popularization of intravenous thrombolysis, more and more people use intravenous thrombolysis to treat related diseases, but problems also arise. There are still a considerable number of patients with early disease after thrombolytic therapy not only not significantly improving, but also progressing, that is, early neurological deterioration (END). In view of this problem, the prediction of END after intravenous thrombolysis becomes very important. With the development of medical technology, research on the prediction of END after intravenous thrombolysis has gradually been carried out. Effective prediction is of great significance for the prevention and treatment of END after intravenous thrombolysis. This article aimed to carry out a meta-analysis of the predictive role of END after intravenous thrombolysis. Through an informed analysis of all studies of this type in this field, this article determines a method for predicting END after intravenous thrombolysis. The actual effect of its role is revealed in this paper, and its purpose is to promote the development of this field. This article addresses the same type of study on the predictive role of neurological deterioration after intravenous thrombolysis. The article performs test and meta-analysis of its role by conditionally searching for literature studies. It is explained using the relevant theoretical formulas. The analysis results show that the prediction of END after intravenous thrombolysis in this paper can effectively help make a preliminary judgment on the possible later neurological deterioration. Although there is an error between the predicted curve and the actual curve, the difference between the two is between 1% and 5%. It can basically effectively predict the occurrence of END. Therefore, the prediction of END after intravenous thrombolysis has a very large preventive effect on the END after intravenous thrombolysis.

show abstract

Differences between predictive factors for early neurological deterioration due to hemorrhagic and ischemic insults following intravenous recombinant tissue plasminogen activator

Cited by 19 publications

References 29 publications

<p>Risk Factors and a Nomogram for Predicting Intracranial Hemorrhage in Stroke Patients Undergoing Thrombolysis</p>

<p>Risk Factors and a Nomogram for Predicting Intracranial Hemorrhage in Stroke Patients Undergoing Thrombolysis</p>

Causes, Predictors, and Timing of Early Neurological Deterioration and Symptomatic Intracranial Hemorrhage After Administration of IV tPA

Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis

Contact Info

Product

Resources

About