Mortality of stroke patients treated with thrombolysis: Analysis of nationwide inpatient sample

Kurth, Tobias; Heuschmann, P. U.; Walker, A. M.; Berger, K.; Flaherty, M. L.; Kissela, B.; Khatri, P.; Dubinsky, R. M.; Lai, S. M.

doi:10.1212/01.wnl.0000258816.02021.b9

Cited by 4 publications

(6 citation statements)

References 12 publications

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“…In unadjusted analyses, mortality (vs survival) in the NIS cohort was associated with the demographic variables of older age (75.1 vs 69.3 years, p < 0.001), non-Hispanic white race (73.6% vs 68.3%, p < 0.001), atrial fibrillation (45.0% vs 24.9%, p < 0.001), and higher median NIHSS score (20)(21)(22)(23)(24)(25) vs 4 [IQR 2-8], p < 0.001; Table 1). In the harmonized cohort, mortality (vs survival) was associated with older age (73.6 vs 65.5 years, p < 0.001), diabetes (36.2% vs 28.3%, p < 0.001), atrial fibrillation (31.9% vs 13.4%, p < 0.001), and higher median NIHSS score (19)(20)(21)(22) vs 3 [1][2][3][4][5][6][7][8][9][10], p < 0.001). The multivariable models did not have evidence of multicollinearity in either cohort (mean VIF in NIS cohort 2.67 and in harmonized cohort 2.13).…”

Section: Resultsmentioning

confidence: 99%

“…A meta‐analysis of the ECASS‐1, ECASS‐2, ECASS‐3, and ATLANTIS trials also failed to show a survival benefit for IV‐tPA, but was likewise underpowered 47 . A prior analysis of NIS data suggested that IV‐tPA increased mortality, but the analysis was not adjusted for stroke severity and, thus, inherently flawed 3,4 …”

Section: Discussionmentioning

confidence: 99%

“…Stroke severity is a risk factor for unfavorable outcome in AIS patients 2 . However, the impact of stroke severity, measured with the National Institutes of Health Stroke Scale (NIHSS) score, on post‐stroke mortality after IV‐tPA treatment has not been adequately studied 3,4 …”

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confidence: 99%

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Effect of Alteplase on Ischemic Stroke Mortality Is Dependent on Stroke Severity

Havenon

Abbasi

Yaghi

et al. 2023

Annals of Neurology

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Objective: Although intravenous alteplase (IV-tPA) has a beneficial effect on functional outcome after ischemic stroke (IS), prior studies of IV-tPA's impact on post-stroke mortality did not have sufficient representation of more severe stroke. Methods: We determined if the interaction between the baseline National Institutes of Health (NIH) Stroke Scale (NIHSS) and IV-tPA modified the risk of mortality after IS in two cohorts: (1) National Inpatient Sample 2016-2020, and (2) a harmonized cohort of IS patients from the NINDS IV-tPA, ALIAS part 2, SHINE, FAST-MAG, IMS-III, POINT, and DEFUSE 3 trials. We fit logistic regression models to the outcome of in-hospital mortality (National Inpatient Sample [NIS] cohort) or mortality within 90 days (harmonized cohort), adjusted for baseline variables.Results: We included 198,668 patients in the NIS cohort, of which 14.0% received IV-tPA and 3.4% died in hospital. We included 7,138 patients in the harmonized cohort, of which 33.2% received IV-tPA and 9.4% died by 90 days. Mortality in the NIS cohort was associated with older age, female sex, non-Hispanic white race, atrial fibrillation, and higher NIHSS. In the harmonized cohort, mortality was associated with older age, diabetes, atrial fibrillation, and higher NIHSS. In both cohorts, the interaction between NIHSS and IV-tPA was significant. In the NIS cohort, the separation became significant at NIHSS 15 and in the harmonized cohort at NIHSS 23, at which point, IV-tPA began to have a significant benefit for both in-hospital and 90-day mortality, respectively. Interpretation: IV-tPA is associated with a reduction in both in-hospital and 90-day mortality for patients with more severe IS.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Alteplase on Ischemic Stroke Mortality Is Dependent on Stroke Severity

Havenon

Abbasi

Yaghi

et al. 2023

Annals of Neurology

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“…The treatment window using tPA is in 4.5 h when patients show the stroke symptom, and the outcomes dramatically decrease beyond 4.5 h [ 35 ]. However, tPA treatment may potentially cause the intracerebral hemorrhage and lead to more mortality [ 36 ]. When patients appear with a large artery occlusion (the clot burden is high) or tPA treatment is beyond the best time window, the MT surgery is an alternative strategy to treat ischemic stroke.…”

Section: Pathology Of Stroke and Current Therapiesmentioning

confidence: 99%

Nanomedicine for Ischemic Stroke

Dong

Gao

et al. 2020

IJMS

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Stroke is a severe brain disease leading to disability and death. Ischemic stroke dominates in stroke cases, and there are no effective therapies in clinic, partly due to the challenges in delivering therapeutics to ischemic sites in the brain. This review is focused on the current knowledge of pathogenesis in ischemic stroke, and its potential therapies and diagnosis. Furthermore, we present recent advances in developments of nanoparticle-based therapeutics for improved treatment of ischemic stroke using polymeric NPs, liposomes and cell-derived nanovesicles. We also address several critical questions in ischemic stroke, such as understanding how nanoparticles cross the blood brain barrier and developing in vivo imaging technologies to address this critical question. Finally, we discuss new opportunities in developing novel therapeutics by targeting activated brain endothelium and inflammatory neutrophils to improve the current therapies for ischemic stroke.

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“…Globally, tPA application is the most widely accepted and implemented treatment method for ischemic stroke, although it is only effective when quickly applied in the time window of 4.5 h following the initiation of stroke ( Yoo et al, 2011 ), and in some cases it can go up to 6 h ( Snelling et al, 2019 ). In addition to the narrow time window, there is a certain risk of reperfusion damage that makes the treatment capacity of tPA limited on most patients ( Kurth et al, 2007 ). If the size of the clot occluding the vein is large than the tPA treatment limits or the time window is outlasted, MT surgery is the alternative treatment in which a microcatheter is used to directly remove the clot, although it is a risk involved solution that is far from being perfect ( Dong et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Glutamate Scavenging as a Neuroreparative Strategy in Ischemic Stroke

et al. 2022

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Stroke is the second highest reason of death in the world and the leading cause of disability. The ischemic stroke makes up the majority of stroke cases that occur due to the blockage of blood vessels. Therapeutic applications for ischemic stroke include thrombolytic treatments that are in limited usage and only applicable to less than 10% of the total stroke patients, but there are promising new approaches. The main cause of ischemic neuronal death is glutamate excitotoxicity. There have been multiple studies focusing on neuroprotection via reduction of glutamate both in ischemic stroke and other neurodegenerative diseases that ultimately failed due to the obstacles in delivery. At that point, systemic glutamate grabbing, or scavenging is an ingenious way of decreasing glutamate levels upon ischemic stroke. The main advantage of this new therapeutic method is the scavengers working in the circulating blood so that there is no interference with the natural brain neurophysiology. In this review, we explain the molecular mechanisms of ischemic stroke, provide brief information about existing drugs and approaches, and present novel systemic glutamate scavenging methods. This review hopefully will elucidate the potential usage of the introduced therapeutic approaches in stroke patients.

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Mortality of stroke patients treated with thrombolysis: Analysis of nationwide inpatient sample

Cited by 4 publications

References 12 publications

Effect of Alteplase on Ischemic Stroke Mortality Is Dependent on Stroke Severity

Effect of Alteplase on Ischemic Stroke Mortality Is Dependent on Stroke Severity

Nanomedicine for Ischemic Stroke

Glutamate Scavenging as a Neuroreparative Strategy in Ischemic Stroke

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