Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Çetiner, Mustafa; Aydın, Hasan Emre; Güler, Merve; Kabay, Sibel Canbaz; Zorlu, Yaşar

doi:10.1177/1076029618796317

Cited by 8 publications

(16 citation statements)

References 38 publications

(50 reference statements)

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“…However, studies regarding gender and mortality outcome in thrombolytic treatment reported conflicting results. One stroke registry reported that male gender was associated with in-hospital death [27], whereas sex was not associated with in-hospital [27][28][29] and 3month mortality [30,31] in other studies.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of thrombolytic therapy in acute ischemic stroke: mothership, drip-and-ship, and ship-and-drip paradigms

et al. 2020

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Background: Chulalongkorn Stroke Center is a comprehensive stroke center (CSC) located in Bangkok, Thailand. Our stroke network consists of different levels of spoke hospitals, ranging from community hospitals where thrombolytic treatment is not available, to those capable of onsite thrombolytic therapy. This study aimed to assess the time to treatment and outcomes among acute ischemic stroke patients who received thrombolytic treatment in the Chulalongkorn Stroke Network by 1.) Direct arrival at the CSC (mothership) 2.) Telestroke-assisted thrombolytic treatment with secondary transfer to the CSC (drip-and-ship) 3.) Referral from community hospital to the CSC for thrombolytic treatment (ship-and-drip).Methods: Acute ischemic stroke patients who received thrombolytic treatment during January 2016-December 2017 in the Chulalongkorn Stroke Network were studied. Time to treatment and clinical outcomes were compared among treatment groups.Results: There were 273 patients in the study including 147, 87, and 39 patients in mothership, drip-and-ship, and shipand-drip paradigms, respectively. The door-to-needle-time (DTN) and onset-to-needle-time (OTN) times were significantly longest in ship-and-drip group (146.5 ± 62/205.03 ± 44.88 mins) compared to mothership (38 ± 23/155.2 ± 60.54 mins) and drip-and-ship (63.0 ± 44/166.09 ± 87 mins), P < 0.05. There was no significant difference regarding functional independence defined by modified Rankin Scale (mRS) ≤ 2 at 3 months (P = 0.12), in-hospital mortality (P = 0.37), mortality at 3 months (P = 0.73), and symptomatic intracerebral hemorrhage (P = 0.24) among groups.Conclusion: Thrombolytic treatment with drip and ship method under teleconsultation is feasible in Thailand. There was no difference of clinical outcome among the 3 treatment paradigms. However, DTN time and OTN time were longest in the ship-and-drip paradigm.

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Section: Discussionmentioning

confidence: 99%

Outcomes of thrombolytic therapy in acute ischemic stroke: mothership, drip-and-ship, and ship-and-drip paradigms

et al. 2020

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“…In Cetiner's study, pretreatment NIHSS scores, presence of proximal hyperintense middle cerebral artery sign in noncontrast CT brain, cardioembolic stroke, and age ≥80 years were significantly higher in the group with unfavorable functional outcomes. 12 In the Zhao's study on the factors associated with thrombolysis outcome in AIS patients with AF, heart failure, higher systolic BP, blood glucose, and NIHSS score independently predicted unfavorable outcomes. Thrombolysis independently predisposed to a favorable outcome but did not significantly reduce mortality.…”

Section: Discussion On Predictors Of An Unfavorable Outcomementioning

confidence: 99%

“…We analyzed the following variables: age, gender, domestic arrangements (living alone or with family members), ongoing medications, histories of vascular risk factors including hypertension, diabetes mellitus, heart diseases (ischemic heart disease, low ejection fraction [EF], and atrial fibrillation [AF], either as a history of AF or AF diagnosed during the index admission by electrocardiography), TIA, current or former smoking, and hypercholesterolemia. At admission, the stroke severity was ascertained by a neurologist experienced in NIHSS evaluation and was classified as mild (0-4), moderate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), or severe . According to the Bamford criteria, 8 strokes were classified in total anterior circulation stroke (TACS), partial anterior circulation stroke, posterior circulation stroke, and lacunar stroke.…”

Section: Study Settingmentioning

confidence: 99%

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Das

Mondal

Bhattacharya

et al. 2020

JNRP

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Background Thrombolysis improves the outcome in acute ischemic stroke (AIS), albeit with an increased risk of symptomatic intracranial hemorrhage (sICH). Biomarkers to find patients at risk of sICH, and guide treatment and prognosis would be valuable. Methods Consecutive patients of AIS thrombolysed between February 2017 and September 2019 at Calcutta National Medical College were studied prospectively for sICH and outcome at 6-month follow-up. We identified the independent risk factors for unfavorable outcomes, mortality, and sICH using multivariate analysis. Prethrombolysis and 24-hour postthrombolysis fibrinogen levels were estimated to evaluate its biomarker role. Results Out of 180 AIS patients admitted during the study period, 60 patients were thrombolysed. Door to needle time was <3 hours among 24 patients and 3 to 4.5 hours among 36 patients. Favorable outcomes occurred among 76.67% and sICH occurred among 13.33% patients. Upper tertile of National Institute of Health Stroke Scale (NIHSS) had the highest adjusted odds for sICH (17.5 [95% confidence intervals=1.7–178.44]). Total anterior circulation stroke had the highest adjusted odds for unfavorable outcome (19.11 [3.9–92.6]). Following thrombolysis, the mean (standard deviation) fibrinogen level of 449.27 (32.87) decreased 7% to postthrombolysis level of 420 (20.5; p< 0.0001). Higher tertiles of fibrinogen levels had progressively increasing odds for morbidity and sICH. Conclusion Congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke (double weight), i.e., CHADS2 score >2, low ejection fraction, the occurrence of total anterior circulation stroke and higher mean arterial blood pressure, blood glucose level, NIHSS score, and fibrinogen at admission were the common risk factors significantly predicting postthrombolysis sICH and morbidity. Antiplatelet and anticoagulant therapy, lower ASPECT (Alberta Stroke Program Early CT Score), and higher SEDAN scores also predicted sICH . Fibrinogen levels were significantly higher among those developing sICH and having unfavorable outcome. The performance of thrombolysis within 3 hours or between 3 and 4.5 hours after symptom onset did not affect morbidity, mortality, or the occurrence of sICH.

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“…It has been found that alteplase increased the likelihood of sICH [21]. In previous studies [15,17,19,22], after 3 months of follow-up from rt-PA, the rate of sICH varied between 3.4 and 14.2%. A lower percentage of sICH (2.4% for alteplase patients vs 0.2% for placebo patients) has been reported [9].…”

Section: Discussionmentioning

confidence: 89%

“…Female sex and older age had a non-significant effect on the outcome 3 months after IV alteplase. The effect of sex and age on the outcome is uncertain and a matter of controversy [3,17,[19][20][21][22]. The mean baseline NIHSS among our thrombolyzed patients with favorable outcomes was significantly lower than those with unfavorable outcomes.…”

Section: Discussionmentioning

confidence: 99%

Short-term outcome in ischemic stroke patients after thrombolytic therapy

Mohamed

Ghaffar

Gawad

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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Background Stroke represents the second leading cause of death in the world after myocardial infarction. Intravenous (IV) thrombolysis with recombinant tissue plasminogen activator (alteplase, rt-PA) is the only pharmacological therapy that was approved for treatment within 4.5 h of acute ischemic stroke (AIS) onset. We aimed to predict the 3-month outcome of AIS patients who received alteplase regarding mortality, spontaneous intra-cerebral hemorrhage (sICH), and functional outcome in comparison with non-thrombolyzed patients and to evaluate the predictors of the outcome after 3 months. Methods All the clinical, National Institute of Health Stroke Scale (NIHSS) scores, radiological, and laboratory data of 40 AIS patients and received rt-PA during the period from 2016 to 2018 were collected and analyzed retrospectively. For comparison, 40 patients, as a control group, were selected to match the alteplase group as regards the baseline data and received regular treatment, rather than rt-PA within the first 24 h, that were obtained. The outcome of the thrombolyzed patients after 3 months was evaluated in comparison with controls by using a modified ranking scale. Results After a 90-day follow-up period, the death rate was slightly higher among the rt-PA group (7.5%) in comparison with the control group (5%). sICH occurred in 7.5% of the patients in the alteplase group and in 5% of the non-thrombolyzed patients; however, this difference was not significant. More patients had a favorable outcome (mRS = 0–2) in the rt-PA group than in the control group (65% vs 60%, OR 1.38, 95% CI 0.50–3.6, P = 0.51). NIHSS score on admission, body mass index (BMI) (≥ 30), and previous transient ischemic attacks (TIA)/previous ischemic stroke were significant predictors of outcome after IV thrombolysis. Age, sex, hypertension (HTN), diabetes mellitus (DM), dyslipidemia, smoking, atrial fibrillation (AF), stroke subtype, size of infarction, and hyperdense middle cerebral artery had a non-significant effect. Conclusion After 3 months of follow-up, rt-PA had a non-significant more increase of favorable outcome with increased risk of sICH and death than controls. Baseline NIHSS, BMI, and history of TIA or previous ischemic stroke were significant predictors of outcome after thrombolysis.

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Predictive Factors for Functional Outcomes After Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Cited by 8 publications

References 38 publications

Outcomes of thrombolytic therapy in acute ischemic stroke: mothership, drip-and-ship, and ship-and-drip paradigms

Outcomes of thrombolytic therapy in acute ischemic stroke: mothership, drip-and-ship, and ship-and-drip paradigms

Predictors of Postthrombolysis Outcome and Symptomatic Postthrombolysis Hemorrhage following Intravenous Thrombolysis with Alteplase for Acute Ischemic Stroke

Short-term outcome in ischemic stroke patients after thrombolytic therapy

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