Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Abstract

Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

“…Moreover, lower heart rates are associated with better functional outcomes in stroke recovery [25]. In our current study, heart rate for 65-74 years old is 83.3-87.6 and 76.9-80.6 for ≥75 years AIS-HF patients and comparable to other studies in AIS patients with poor outcomes [24,26,27]. The link between elevated heart rate and the observed stroke severity in our AIS-HF patient population may be due to the compensatory rise in heart rate mechanisms and their inability to compensate.…”

Acute Ischemic Stroke and Heart Failure: Stroke Risk Factors Associated with Exclusion from Thrombolytic Therapy

“… 29 Estimates of eligibility for rtPA in the AIS population are reported to range from 6% to 8% of all strokes. 33 , 34 While the most common exclusion factor for rtPA is the delay in presentation for treatment, comorbidities such as history of coronary artery stenosis, 35 , 36 previous stroke, 29 , 37 elevated lipids, 38 INR, 39 creatinine, 31 and heart rate 21 have been reported to contribute to the low eligibility rate for rtPA.…”