Intravenous Tissue Plasminogen Activator for Wake-Up Stroke: A Propensity Score-Matched Analysis

Anaissie, James; Monlezun, Dominique; Siegler, James E.; Waring, Elizabeth; Dowell, Lauren; Samai, Alyana; George, Alexander; Kimbrough, Tara; Berthaud, Jimmy V.; Martin‐Schild, Sheryl

doi:10.1016/j.jstrokecerebrovasdis.2016.06.044

Cited by 13 publications

(20 citation statements)

References 26 publications

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“…Six countries contributed to the production of the studies: USA [15, 16], Germany [12, 28], Switzerland [29], Korea [16], UK [27], and Canada [25]. Among them, 3 were retrospective studies [15, 25, 26], 3 were prospective studies [16, 27, 28], and 2 were RCTs [12, 29]. The Toast classification was available in 7 studies [15, 16, 25–27, 29], and one single study only enrolled those patients with proximal large artery occlusion [25].…”

Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Luan

Zhang

Yang

et al. 2019

Behavioural Neurology

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Objectives. Unknown onset stroke (UOS) is usually excluded from intravenous thrombolysis concerning the unclear symptom onset time. Attempts have been done to use thrombolytic therapy in these patients. The current meta-analysis was done to examine the efficacy and safety of intravenous thrombolysis in UOS. Methods. PubMed, Web of Science, and Cochrane Library were searched for studies comparing thrombolysis with conservative therapy among UOSs. Data of good outcome (mRS, 0-2), mortality, and intracerebral hemorrhage (ICH) and symptomatic ICH (sICH) were extracted and analyzed using the Revman 5.2 software. Results. In total, 8 studies with 1271 subjects (542 with thrombolysis and 729 with conservative therapy) were included in this meta-analysis. The data showed that patients receiving thrombolysis had a higher incidence of 90-day good outcome (P=0.0005) than conservative therapy. The comparison of discharge (P=0.89) and 90-day mortality (P=0.10) in both groups did not find any significances. The incidences of ICH (P=0.42) and sICH (P=0.06) were relatively comparable between the two therapies. Conclusions. Intravenous thrombolysis is a better choice for UOS patients for its efficacy and safety. In addition, pretreatment imaging assessment is beneficial for improving the efficacy of thrombolytic therapy. However, it needs more supporting evidences for clinical use in the future.

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Section: Resultsmentioning

confidence: 99%

Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Luan

Zhang

Yang

et al. 2019

Behavioural Neurology

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“…Finally, a total of 12 studies published between 2008 and 2018 with 3,084 patients were included in the meta-analysis. 2,[12][13][14][15][16][17][19][20][21][22][23] All the patients had an ischemic lesion that was visible on imaging including noncontrast-enhanced computed tomography (NCCT), computed tomography perfusion imaging (CTP), or magnetic resonance imaging (MRI). The clinical and imaging criteria for the use of thrombolytic treatment for patients in individual studies is demonstrated in Table. Atrial fibrillation was present at baseline in 11.6-60.0% of the patients, and previous stroke was diagnosed in 6.9-40.8% of the patients.…”

Section: Search Results and Methodological Assessmentmentioning

confidence: 99%

“…Four studies were retrospective trials, [12][13][14]21 the remaining 8 were prospective studies, 2, 15-17, 19, 20, 22, 23 and one trial was stopped early due to funding cessation without an interim analysis of trial data. 2 Among these articles, the efficacy of thrombolytic treatment was compared between thrombolyzed UTOS patients and non-thrombolyzed UTOS patients in 7 studies, 2,[12][13][14][15][16][17] while the efficacy of thrombolytic treatment for thrombolyzed UTOS patients was compared with that of thrombolyzed KOS patients in 8 studies. 13, 15-17, 19, 21-23 (Table I in To guide our methodological assessment of the included studies, we adopted Hayden's criteria for a quality assessment of prognostic studies to evaluate the potential bias of the included studies.…”

Section: Search Results and Methodological Assessmentmentioning

confidence: 99%

“…Clinical criteria Time window Imaging criteria Anaissie, 2016 Neurologically normal before going to sleep and deficits upon awakening for >3 h; had been treated with IV tPA; no contraindications to IV tPA.…”

Section: Studymentioning

confidence: 99%

“…Indeed, numerous articles have previously reported better clinical outcomes and similar side effects, including spontaneous intracerebral hemorrhage (SICH) and mortality, in UTOS patients treated with thrombolysis than in UTOS patients who were not treated with thrombolysis; 13,14 however, such a correlation has not been found in other studies. 12,[15][16][17] The latest attempt to include UTOS patients in an early acute stroke treatment trial was the MRIbased thrombolysis in wake-up stroke trial. 2 This trial was stopped after the recruitment of 503 of a planned 800 patients with a superiority of thrombolysis in the rt-PA group (mRS 0-1 in 53.3% patients)…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of thrombolytic therapy for stroke with unknown time of onset: a meta-analysis

Zhu

Xie

et al. 2019

Preprint

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Background and Purpose: Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies available for patients with known-onset stroke (KOS). Whether rt-PA treatment would improve functional outcomes in patients with stroke with unknown time of onset (UTOS) is undetermined. We aimed to systematically assess the efficacy and safety of thrombolysis for UTOS patients in this meta-analysis. Methods: A systematic literature search of Medline, Embase and Cochrane Library was conducted. We considered the relevant data comparing thrombolyzed UTOS patients vs. non-thrombolyzed UTOS patients or thrombolyzed UTOS patients vs. thrombolyzed KOS patients. Treatment efficacy and safety were measured according to modified Rankin Scale scores of 0-2 (mRS 0-2), and the presence of spontaneous intracerebral hemorrhage (SICH) or mortality at 90 days respectively. Results: A total of 12 studies with 3,084 patients from both clinical trial and database registries meeting the inclusion criteria were included in the meta-analysis. All the patients had an ischemic lesion that was assessed by imaging including computed tomography (CT) or magnetic resonance imaging (MRI). Among these studies, 7 compared the thrombolytic efficacy in thrombolyzed UTOS patients with that in non-thrombolyzed UTOS patients (mRS 0-2: odds ratio (OR)=1.65, 95% CI 1.19-2.27, P= 0.002), and 8 studies compared thrombolyzed UTOS patients with thrombolyzed KOS patients (mRS 0-2: OR=0.87, 95% CI 0.66-1.15, P=0.26). The incidence of SICH was higher in thrombolyzed UTOS patients than in non-thrombolyzed UTOS patients (OR 3.07, 95% CI 1.12-8.43, P=0.03), but there was no difference between thrombolyzed UTOS patients and thrombolyzed KOS patients (OR=1.10, 95% CI 0.55-2.22, P=0.79) at 90 days. Mortality was not different between thrombolyzed UTOS patients and non-thrombolyzed UTOS patients (OR=1.14, 95% CI 0.46-2.83, P=0.77) or between thrombolyzed UTOS patients and thrombolyzed KOS patients (OR=0.68, 95% CI 0.40-1.16, P=0.15). Conclusions: Compared with non-thrombolyzed patients, imaging-guided thrombolysis for UTOS patients had significantly favorable outcomes and more intracranial hemorrhage at 90 days. Keywords: Efficacy, safety, thrombolysis, unclear-onset stroke, meta-analysis

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Stress cardiomyopathy in hospitalized patients with cancer: machine learning analysis by primary malignancy type

et al. 2021

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Aims Previous studies have shown that patients with stress (Takotsubo) cardiomyopathy (SC) and cancer have higher in‐hospital mortality than patients with SC alone. No studies have examined outcomes in patients with active cancer and SC compared to patients with active cancer without SC. We aimed to assess the potential association between primary malignancy type and SC and their shared interaction with inpatient mortality. Methods and results We analysed SC by primary malignancy type with propensity score adjusted multivariable regression and machine learning analysis using the 2016 United States National Inpatient Sample. Of 30 195 722 adult hospitalized patients, 4 719 591 had active cancer, of whom 568 239 had SC. The mean age of patients with cancer and SC was 69.1, of which 74.7% were women. Among patients with cancer, those with SC were more likely to be female and have white race, Medicare insurance, hypertension, heart failure with reduced ejection fraction, obesity, cerebrovascular disease, anaemia, and chronic obstructive pulmonary disease (P < 0.003 for all). In machine learning‐augmented, propensity score multivariable regression adjusted for age, race, and income, only lung cancer [OR 1.25; 95% CI: 1.08–1.46; P = 0.003] and breast cancer [OR 1.81; 95% CI: 1.62–2.02; P < 0.001] were associated with a significantly increased likelihood of SC. Neither SC alone nor having both SC and cancer was significantly associated with in‐hospital mortality. The presence of concomitant SC and breast cancer was significantly associated with reduced mortality (OR 0.48; 95% CI: 0.25–0.94; P = 0.032). Conclusions This analysis demonstrates that primary malignancy type influences the likelihood of developing SC. Further studies will be necessary to delineate characteristics in patients with lung cancer and breast cancer which contribute to development of SC. Additional investigation should confirm lower mortality in patients with SC and breast cancer and determine possible explanations and protective factors.

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Intravenous Tissue Plasminogen Activator for Wake-Up Stroke: A Propensity Score-Matched Analysis

Cited by 13 publications

References 26 publications

Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Efficacy and Safety of Intravenous Thrombolysis in Patients with Unknown Onset Stroke: A Meta-Analysis

Efficacy and safety of thrombolytic therapy for stroke with unknown time of onset: a meta-analysis

Stress cardiomyopathy in hospitalized patients with cancer: machine learning analysis by primary malignancy type

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