Influence of Racial Differences on Outcomes after Thrombolytic Therapy in Acute Ischemic Stroke

Mishra, Nishant K.; Chen, Christopher; Grotta, James C.; Lees, Kennedy R.; Kent, Thomas A.

doi:10.1111/ijs.12162

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…However, race and ethnic differences can influence the outcome of thrombolysis in acute ischemic stroke patients. 27 The other nomogram model, which includes 4 variables (age, atrial fibrillation, NIHSS score and glucose level on admission), was developed for Asian patients. 14 However, the study did not include information about the total dose of r-tPA, and the percentage of ICH is reported to be higher (18.9%) in Asian populations at standard doses compared to the percentage of ICH in most Chinese studies.…”

Section: Discussionmentioning

confidence: 99%

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

Yin¹,

Niu²,

Liang³

et al. 2020

NDT

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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.

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Section: Discussionmentioning

confidence: 99%

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

Yin¹,

Niu²,

Liang³

et al. 2020

NDT

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“…With the increased use of tPA, studies should evaluate the impact of its use on postrehabilitation outcomes. Studies suggest that response to tPA may differ by race/ethnicity and it is possible that this difference may translate into a differential effect on prerehabilitation baseline outcomes and subsequently postrehabilitation outcomes [ 43 – 45 ]. In addition, access to care must be accounted for in studies of disparities in outcomes.…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Ellis

Hyacinth

Beckett

et al. 2014

Stroke Research and Treatment

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Background. Significant racial and ethnic disparities in stroke incidence, severity, and morbidity have been consistently reported; however, less is known about potential differences in poststroke rehabilitation outcomes. Objective. To examine racial and ethnic differences in poststroke rehabilitation outcomes. Methods. We completed an in-depth search of Medline and several major journals dedicated to publishing research articles on stroke, rehabilitation, and racial-ethnic patterns of disease over a 10-year period (2003–2012). We identified studies that reported rehabilitation outcomes and the race or ethnicity of at least two groups. Results. 17 studies involving 429,108 stroke survivors met inclusion criteria for the review. The majority (94%) of studies examined outcomes between Blacks and Whites. Of those studies examining outcomes between Blacks and Whites, 59% showed that Blacks were generally less likely to achieve equivalent functional improvement following rehabilitation. Blacks were more likely to experience lower FIM gain or change scores (range: 1–60%) and more likely to have lower efficiency scores (range: 5–16%) than Whites. Conclusions. Black stroke survivors appear to generally achieve poorer functional outcomes than White stroke survivors. Future studies are warranted to evaluate the precise magnitude of these differences, whether they go beyond chance, and the underlying contributory mechanisms.

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“…Weighted Euclidean matching of nearest neighbors in a 3-D space of baseline NIHSS, age, and glucose was adopted as published. 4,8 Weighting factors for NIHSS and age were derived by dividing the mean of glucose by the mean of NIHSS and age so that no variable exerts an undue influence on the calculation of 3-D distances. 8 See Supplementary Material for an explanation of matching algorithms.…”

Section: Matching Methodsmentioning

confidence: 99%

“…Despite variable access to resources, recombinant tissue plasminogen activator (rt-PA) has been utilized worldwide, and several stroke registries have been maintained. 3 While outcomes from some of these registries and databases have been compared across different populations, 3,4 comparisons done outside large, randomized controlled trials (RCTs) are complicated by differences in baseline factors that can bias interpretations. 5À7 Matching between patients on baseline factors has been employed successfully to account for such imbalances.…”

Section: Introductionmentioning

confidence: 99%

Thrombolysis Experience in Costa Rica Compared Against Individual Patient Data from two Randomized Controlled Trials

Torrealba‐Acosta

Barboza-Elizondo

Fernández-Morales

et al. 2022

Journal of Stroke and Cerebrovascular Diseases

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Influence of Racial Differences on Outcomes after Thrombolytic Therapy in Acute Ischemic Stroke

Abstract: These results do not suggest a differential response to tissue plasminogen activator based on race ethnicity. Among Asians, data were particularly sparse, and results should be interpreted with caution.

Cited by 7 publications

References 28 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>

Racial/Ethnic Differences in Poststroke Rehabilitation Outcomes

Thrombolysis Experience in Costa Rica Compared Against Individual Patient Data from two Randomized Controlled Trials

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