Tissue plasminogen activator (rt-PA) in acute ischemic stroke: Outcomes associated with ambulation

Lawson, T R; Brown, Ian E.; Westerkam, D L; Blackhurst, Dawn W.; Sternberg, Shannon; Leacock, Rodney O.; Nathaniel, Thomas I.

doi:10.3233/rnn-140480

Cited by 24 publications

(25 citation statements)

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“…Data on clinical characteristics and laboratory analysis were collected directly from the stroke registry. The registry has been described in previous studies . Collected data included patients medical history factors of: hypertension, coronary artery disease, dyslipidemia, atrial fibrillation/atrial flutter, previous stroke, previous TIA, congestive heart failure (CHF), carotid artery stenosis, peripheral vascular disease, history of smoking, and diabetes.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, an accurate knowledge of ambulatory activities before and after recovery is important to evaluate functional outcome following thrombolysis therapy in anti‐HTN‐treated stroke patients. In addition, ischemic stroke is a common etiology for physical immobility, and the recovery of motor functions would provide a direct evaluation of daily life mobility before, after thrombolysis treatment, and during the recovery period. The current study analyzed the ambulatory activities to develop functional outcome measures that predicted baseline clinical characteristics associated functional outcome in thrombolyzed stroke patients with a pretreatment history of antihypertensive medication.…”

Section: Introductionmentioning

confidence: 99%

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Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Fleming

Blum

Averkamp

et al. 2019

J of Clinical Hypertension

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There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non‐randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti‐HTN) medication, only NIHSS score (OR = 1.094, 95% CI, 1.094‐1.000, P = 0.005) was associated with improved functional outcome while patients with congestive heart failure (OR = 0.385, 95% CI, 0.385‐0.159, P = 0.035) and patients with a history of previous TIA (OR = 0.302, 95% CI, 0.302‐0.113, P = 0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Fleming

Blum

Averkamp

et al. 2019

J of Clinical Hypertension

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“…For different subtypes of stroke, current clinical management has been limited to thrombolysis/thrombectomy, hematoma evacuation, and prevention of stroke recurrence or stroke-related complications 2,42 . Until now, no other effective treatment for acute stroke exists, especially in terms of neuroprotection or neurogenesis 11 .…”

Section: Discussionmentioning

confidence: 99%

Intraventricular Medium B Treatment Benefits an Ischemic Stroke Rodent Model via Enhancement of Neurogenesis and Anti-apoptosis

Chen

Tsai

Chen

et al. 2020

Sci Rep

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Enhancement of endogenous neurogenesis after ischemic stroke may improve functional recovery. We previously demonstrated that medium B, which is a combination with epidermal growth factor (EGF) and fibronectin, can promote neural stem/progenitor cell (NSPC) proliferation and migration. Here, we showed that medium B promoted proliferation and migration of cultured NSPCs onto various 3-dimentional structures. When rat cortical neurons with oxygen glucose deprivation (OGD) were cocultured with NSPCs, medium B treatment increased neuronal viability and reduced cell apoptosis. In a rat model with transient middle cerebral artery occlusion (MCAO), post-insult intraventricular medium B treatment enhanced proliferation, migration, and neuronal differentiation of NSPCs and diminished cell apoptosis in the infarct brain. In cultured post-OGD neuronal cells and the infarct brain from MCAO rats, medium B treatment increased protein levels of Bcl-xL, Bcl-2, phospho-Akt, phospho-GSK-3β, and β-catenin and decreased the cleaved caspase-3 level, which may be associated with the effects of anti-apoptosis. Notably, intraventricular medium B treatment increased neuronal density, improved motor function and reduced infarct size in MCAO rats. In summary, medium B treatment results in less neuronal death and better functional outcome in both cellular and rodent models of ischemic stroke, probably via promotion of neurogenesis and reduction of apoptosis.

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“…Changes in ambulation were tracked from admission to discharge to evaluate potential risks and benefits of rtPA therapy in stroke patients. The validity of the scoring has been described in a previous study [19].…”

Section: Methodsmentioning

confidence: 99%

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

Scalise

Gainey

Bailes

et al. 2018

Preprint

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Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

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Tissue plasminogen activator (rt-PA) in acute ischemic stroke: Outcomes associated with ambulation

Abstract: Our current study indicates that early treatment with rt-PA may be associated with favorable changes in ambulatory status from admission to discharge following acute ischemic stroke.

Cited by 24 publications

References 0 publications

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Intraventricular Medium B Treatment Benefits an Ischemic Stroke Rodent Model via Enhancement of Neurogenesis and Anti-apoptosis

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

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