Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke

Gensicke, Henrik; Strbian, Daniel; Zinkstok, Sanne M.; Scheitz, Jan F.; Bill, Olivier; Hametner, Christian; Moulin, Solène; Zini, Andrea; Kägi, Georg; Pezzini, Alessandro; Padjen, Višnja; Béjot, Yannick; Corbière, Sydney; Zonneveld, Thomas P.; Seiffge, David J; Roos, Yvo B.W.E.M.; Traenka, Christopher; Putaala, Jukka; Peters, Nils; Bonati, Leo H.; Curtze, Sami; Erdur, Hebun; Sibolt, Gerli; Koch, Peter; Vandelli, Laura; Ringleb, Peter A.; Leys, Didier; Cordonnier, Charlotte; Michel, Patrik; Nolte, Christian H.; Lyrer, Philippe; Tatlısumak, Turgut; Nederkoorn, Paul J.; Engelter, Stefan T.

doi:10.1161/strokeaha.115.011674

Cited by 68 publications

(74 citation statements)

References 20 publications

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“…[16][17][18][19] Local study investigators completed the forms using prospectively ascertained in-hospital IVT registries. Completed forms from all centers were compiled in the coordinating center in Amsterdam, where data were pooled and analyzed as described previously.…”

Section: Methods Study Population Procedures and Outcomesmentioning

confidence: 99%

“…mRS scores were obtained by the local center through a telephone interview or by outpatient clinic visit with the patient or caregiver, as described in previous research. [16][17][18][19] Safety measures were symptomatic intracranial hemorrhage and mortality at 3 months. Symptomatic intracranial hemorrhage was defined according to the criteria of the European Cooperative Acute Stroke Study II: any hemorrhage with neurological deterioration, indicated by a National Institute of Health Stroke Scale score ≥4 than the value at baseline or the lowest value within 7 days, or any hemorrhage leading to death.…”

Section: Methods Study Population Procedures and Outcomesmentioning

confidence: 99%

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Sex Differences and Functional Outcome After Intravenous Thrombolysis

Spaander

Zinkstok

Baharoglu

et al. 2017

Stroke

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In patients with acute stroke, previous research has also shown sex to affect outcome after intravenous thrombolysis (IVT) treatment; although outcome was similar between men and women treated with placebo, outcome was better in women after IVT. 4 The biological explanation for this difference remains unclear.A possible explanation could be the difference in recanalization. Women have more cardioembolic strokes, with uniform fibrin-rich clots and therefore a higher affinity of alteplase, resulting in more frequent, faster, and complete recanalization. [5][6][7] Another suggested mechanism could be a difference in endogenous fibrinolysis because of differences in sex hormones between men and women. Estrogen has an indirect influence on the controlling of the fibrinolytic system, as well as a direct neuroprotective activity. [8][9][10][11] However, there are no convincing data to support these hypotheses.Background and Purpose-Women have a worse outcome after stroke compared with men, although in intravenous thrombolysis (IVT)-treated patients, women seem to benefit more. Besides sex differences, age has also a possible effect on functional outcome. The interaction of sex on the functional outcome in IVT-treated patients in relation to age remains complex. The purpose of this study was to compare outcome after IVT between women and men with regard to age in a large multicenter European cohort reflecting daily clinical practice of acute stroke care. Methods-Data were obtained from IVT registries of 12 European tertiary hospitals. The primary outcome was poor functional outcome, defined as a modified Rankin scale score of 3 to 6 at 3 months. We stratified outcome by age in decades. Safety measures were symptomatic intracranial hemorrhage and mortality at 3 months. Results-In this cohort, 9495 patients were treated with IVT, and 4170 (43.9%) were women with a mean age of 71.9 years.After adjustments for baseline differences, female sex remained associated with poor functional outcome (odds ratio, 1.15; 95% confidence interval, 1.02-1.31). There was no association between sex and functional outcome when data were stratified by age. Symptomatic intracranial hemorrhage rate was similar in both sexes (adjusted odds ratio, 0.93; 95% confidence interval, 0.73-1.19), whereas mortality was lower among women (adjusted odds ratio, 0.83; 95% confidence interval, 0.70-0.99). Conclusions-In this large cohort of IVT-treated patients, women more often had poor functional outcome compared with men. This difference was not dependent on age. (Stroke. 2017;48:699-703.

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Section: Methods Study Population Procedures and Outcomesmentioning

confidence: 99%

Section: Methods Study Population Procedures and Outcomesmentioning

confidence: 99%

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Spaander

Zinkstok

Baharoglu

et al. 2017

Stroke

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“…The ThRombolysis in Ischaemic Stroke Patients (TRISP) study is a collaboration of 12 European stroke centres and comprises a cohort of over 10 000 consecutive patients treated with IVT 1. We used data of patients treated up to 31 December 2014 (see online supplementary appendix file 1).…”

Section: Methodsmentioning

confidence: 99%

Non-office-hours admission affects intravenous thrombolysis treatment times and clinical outcome

Zonneveld

Curtze

Zinkstok

et al. 2017

J Neurol Neurosurg Psychiatry

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“…In the UK national stroke audit, pre-stroke mRS is one of the core descriptors collected (11). In practice, decisions on treatment are often based on premorbid function (12). …”

Section: Introductionmentioning

confidence: 99%

Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment

et al. 2017

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Background and purposeThe modified Rankin Scale (mRS) was designed to measure poststroke recovery but is often used to describe pre-stroke disability. We sought to evaluate three aspects of pre-stroke mRS: validity as a measure of pre-stroke disability; prognostic accuracy and association of pre-stroke mRS scores, and process of care.MethodsWe used data from a large, UK clinical registry. For analysis of validity, we compared pre-stroke mRS against other markers of pre-stroke function (age, comorbidity index, care needs). For analysis of prognostic accuracy, we described univariable and multivariable models comparing pre-stroke mRS and other prognostic variables against a variety of outcomes (early and late mortality, length of stay, institutionalization, incident complications). Finally, we described association of pre-stroke mRS and components of evidence-based stroke care (early neuroimaging, admission to stroke unit, assessment of swallow).ResultsWe analyzed data of 2,491 stroke patients. Concurrent validity analyses suggested statistically significant, but modest correlations between pre-stroke mRS and chosen variables (rho >0.40; p < 0.0001 for all). Every point increase of pre-stroke mRS was associated with poorer outcomes for our prognostic variables (unadjusted p < 0.001). This association held when corrected for other covariates. For example, pre-stroke mRS 4–5 odds ratio (OR): 6.84 (95% CI: 4.24–11.03) for 1 year mortality compared to mRS 0 in adjusted model. There was a difference between pre-stroke mRS and treatment, with higher pre-stroke mRS more likely to receive evidence-based care.ConclusionResults suggest that pre-stroke mRS has some concurrent validity and is a robust predictor of prognosis. This association is not explained by the influence of pre-stroke mRS on care pathways.

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Intravenous Thrombolysis in Patients Dependent on the Daily Help of Others Before Stroke

Cited by 68 publications

References 20 publications

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Sex Differences and Functional Outcome After Intravenous Thrombolysis

Non-office-hours admission affects intravenous thrombolysis treatment times and clinical outcome

Pre-Stroke Modified Rankin Scale: Evaluation of Validity, Prognostic Accuracy, and Association with Treatment

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