Intravenous thrombolysis for patients with in‐hospital stroke onset: propensity‐matched analysis from the Safe Implementation of Treatments in Stroke‐East registry

Tsivgoulis, Georgios; Katsanos, Aristeidis H.; Kadlecová, Pavla; Członkowska, Anna; Kobayashi, Adam; Brozman, M; Švigelj, Viktor; Csiba, László; Fekete, Klára; Kõrv, Janika; Demarin, Vida; Vilionskis, Aleksandras; Jatužis, Dalius; Krespi, Yakup; Karapanayiotides, Theodoros; Giannopoulos, Sotirios; Mikulík, Robert

doi:10.1111/ene.13450

Cited by 17 publications

(11 citation statements)

References 15 publications

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“…'s[ 18 ] study, the most disadvantage is the inclusion of some patients with thrombolysis. As in the previous study,[ 11 ] TT was revealed as the leading risk of HT in AIS patients. The actual correlation between GFR and HT could be confounded by TT due to TT are more strongly responsible for the increased HT risk rather than impaired renal function.…”

Section: Discussionsupporting

confidence: 70%

“…[ 9 10 ] The acquisition of HT is more important social concern when interventional management (intravenous or intra-arterial thrombolysis and endovascular therapy) are increasingly used due to which may increase recanalization rate, but at the same time increased the risk of HT. [ 11 ] Therefore, identifying some risk factors predisposing to HT may lead to new preventive strategies. The incidence of kidney dysfunction is higher in stroke patients and, in turn, kidney damage is an important predictor of mortality and all devastating vascular events in patients with AIS.…”

Section: Introductionmentioning

confidence: 99%

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Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy

Liu

2018

Chinese Medical Journal

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Background:Whether there is a relationship between glomerular filtration rate (GFR) and hemorrhagic transformation (HT) after acute ischemic stroke (AIS) is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy (TT).Methods:Consecutive AIS patients without TT were included in this prospective study from January 2014 to December 2016 in the First Affiliated Hospital of Chongqing Medical University. We divided them into two groups (HT and non-HT group) and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT.Results:Among 426 consecutive patients, 74 (17.3%) presented HT (mean age: 65 ± 12 years, number of male patients: 47) on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR (odds ratio [OR] = 3.708, confidence interval [CI] = 1.326–10.693, P = 0.013), atrial fibrillation (AF; OR = 2.444, CI = 1.087–5.356, P = 0.027), large cerebral infarction (OR = 2.583, CI = 1.236–5.262, P = 0.010), and hypoalbuminemia (HA; OR = 4.814, CI = 1.054–22.153, P = 0.037) for AIS patients without TT.Conclusions:The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.

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Section: Discussionsupporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy

Liu

2018

Chinese Medical Journal

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“…Additionally, they found lower thrombolysis rates also caused by significant and often preventable delays: delayed symptom recognition, e.g. due to sedation or less experienced hospital staff[3, 26], less emergency stroke specialist referrals[4, 30, 31], and longer times from stroke onset to imaging or treatment[25, 32]. This combination of higher rates of contraindications to thrombolysis, as well as preventable delays in symptom recognition and diagnosis are plausible explanation for the lower thrombolysis rates found here.…”

Section: Discussionmentioning

confidence: 99%

A comparison of trends in stroke care and outcomes between in-hospital and community-onset stroke – The South London Stroke Register

et al. 2019

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Background Stroke care and outcomes have improved significantly over the past decades. It is unclear if patients who had a stroke in hospital (in-hospital stroke, IHS) experienced similar improvements to those who were admitted with stroke (community-onset stroke, COS). Methods Data from the South London Stroke Register were analysed to estimate trends in processes of care and outcomes across three cohorts (1995–2001, 2002–2008, 2009–2015). Kaplan-Meier survival curves were calculated for each cohort. Associations between patient location at stroke onset, processes of care, and outcomes were investigated using multiple logistic regression and Cox proportional hazards models. Results Of 5,119 patients admitted to hospital and registered between 1995 and 2015, 552(10.8%) had IHS. Brain imaging rates increased from 92.4%(COS) and 78.3%(IHS) in 1995–2001 to 100% for COS and IHS in 2009–2015. Rates of stroke unit admission rose but remained lower for IHS (1995–2001: 32.2%(COS) vs. 12.4%(IHS), 2002–2008: 77.1%(COS) vs. 50.0%(IHS), 2009–2015: 86.3%(COS) vs. 65.4%(IHS)). After adjusting for patient characteristics and case-mix, IHS was independently associated with lower rates of stroke unit admission in each cohort (1995–2001: OR 0.49, 95%CI 0.29–0.82, 2002–2008: 0.29, 0.18–0.45, 2009–2015: 0.22, 0.11–0.43). In 2009–2015, thrombolysis rates were lower for ischaemic IHS (17.8%(COS) vs. 13.8%(IHS)). Despite a decline, in-hospital mortality remained significantly higher after IHS in 2009–2015 (13.7%(COS) vs. 26.7%(IHS)). Five-year mortality rates declined for COS from 58.9%(1995–2001) to 35.2%(2009–2015) and for IHS from 80.8%(1995–2001) to 51.1%(2009–2015). In multivariable analysis, IHS was associated with higher mortality over five years post-stroke in each cohort (1995–2001: HR 1.27, 95%CI 1.03–1.57, 2002–2008: 1.24, 0.99–1.55, 2009–2016: 1.39, 0.95–2.04). Conclusions Despite significant improvements for IHS patients similar to those for COS patients, rates of stroke unit admission and thrombolysis remain lower, and short- and long-term outcomes poorer after IHS. Factors preventing IHS patients from entering evidence-based stroke-specific hospital pathways in a timely fashion need further investigation.

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“…After dichotomization according to the history of dual antiplatelet intake prior to stroke onset, patients in the treatment group (patients with history of dual antiplatelet pretreatment) were matched to control group patients without any prior antiplatelet treatment at stroke onset. For matching, we used a structured, iterative propensity score model with inclusion of all baseline characteristics, except for the history of dual antiplatelet pretreatment, with the primary objective to maximize the balance in the distribution of possible confounders between the 2 aforementioned groups . The corresponding propensity score of the treatment variable (history of dual antiplatelet intake) was calculated for each subject, and a nearest neighbor matching algorithm with a 1:1 allocation was subsequently implemented to match eligible patients in the treatment group (patients with history of dual antiplatelet pretreatment) to patients in the control group (patients without history of antiplatelet pretreatment).…”

Section: Methodsmentioning

confidence: 99%

Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets

Tsivgoulis

Katsanos

Mavridis

et al. 2018

Annals of Neurology

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Intravenous thrombolysis for patients with in‐hospital stroke onset: propensity‐matched analysis from the Safe Implementation of Treatments in Stroke‐East registry

Abstract: Our findings underline the safety and efficacy of IVT for IHS. They also underscore the potential of reducing in-hospital delays for timely tissue plasminogen activator delivery in patients with IHS.

Cited by 17 publications

References 15 publications

Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy

Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy

A comparison of trends in stroke care and outcomes between in-hospital and community-onset stroke – The South London Stroke Register

Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets

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