Stroke is a cerebrovascular disorder characterized by sudden disruption of blood supply into the brain leading to injury and subsequent neurological deficit. It is estimated that the majority of stroke cases (80%) is due to the occlusion of a blood vessel by a clot resulting in an ischemic stroke (Feigin et al., 2015).Complications frequently develop after ischemic stroke and play an important role in determining the final clinical outcome and prognosis in stroke patients. Many of the complications can be prevented
Background: Treating hypertension (HTN) in acute ischemic stroke (AIS) is controversial, since both extremely high and low blood pressures (BP) are associated with poor outcomes. Objective: This study was designed to describe and assess the frequency and the factors affecting BP overtreatment in AIS. Methods and material: This was a retrospective observational study conducted at Lebanese hospitals. BP readings at baseline and after treatment with antihypertensive drugs were recorded. Overtreatment was defined as baseline BP below 220/120 mmHg and an antihypertensive drug was prescribed. Results: A total of 141 patients were enrolled with a mean age of 76.89 years and 43.3% were males. Overtreatment rate was 62.6%, and was significantly more common in patients with a previous history of HTN and hyperlipidemia. In addition, overtreatment was significantly more common in patients treated with antihypertensive drugs, had high modified Rankin Scale score (>2) at baseline, and had high systolic BP at baseline (p < 0.05). Results of multivariate analysis revealed that the highest risk of overtreatment was significantly shown in patients who had HTN (OR = 4.589, p = 0.017), and who had high systolic BP at baseline (OR = 1.061, p = 0.001). Conclusion: BP management in AIS was generally not consistent with the guidelines. This supports the need for further research to investigate the effects of BP overtreatment on patient outcomes.
Background:
Ischemic stroke accounts for around 87% of all strokes worldwide and is the second leading cause of mortality and a significant factor of disability in adults. The objective of this study was to assess the adherence to international treatment guidelines for ischemic stroke in Lebanese hospitals and evaluate factors associated with in-hospital mortality.
Methods:
This retrospective observational study was conducted in three Lebanese hospitals between January 2018 and December 2019. All adult patients diagnosed with ischemic stroke and who were subsequently admitted and treated in the internal medicine department, intensive care unit, or coronary care units were included in the study.
Results:
Out of 292 patients with stroke, 56.8 % were females with hypertension being the most common previous disease (38.4%). Concerning acute management, 94.5% had an early brain imaging performed upon hospital presentation, 14.4% were eligible for emergency reperfusion, 2.1% were prescribed fibrinolytic therapy, 50% were adherent with acute hypertension treatment, and 6.2% were adherent with the antiplatelet regimen recommendation. The results highlight that right sided hemiparesis, decreased level of consciousness, and hyperthermia (T > 38°C) were significantly associated with in-hospital death. Guideline adherence for all the acute treatment measures and management strategies was 90.2 %.
Conclusion:
The study highlights that guideline recommendations were not uniformly applied among all patients, and those recommendation standards set by the guidelines were not applied among all hospitals.
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