Acute ischemic stroke patients with diabetes should not be excluded from intravenous thrombolysis

Abstract

The benefit of intravenous thrombolysis (IVT) has been questioned for patients with diabetes mellitus (DM) in cases of acute ischemic stroke (IS). Our objective was to analyze the differences in outcome according to prior diagnosis of DM and the use or not of IVT. Observational study with inclusion of consecutive IS patients admitted to an stroke unit. Demographic data, vascular risk factors, comorbidity, stroke severity and 3-month follow-up outcome (modified Rankin Scale) were compared according to prior diagnosis of DM and the use or not of IVT. A total of 1,139 IS patients were admitted; 283 (24.8%) patients had a diagnosis of DM, and 261 were IVT treated (23.2% of the group without DM and 21.9% of the DM group). The IVT-treated patients with DM were older, had more comorbidities and had higher glucose levels on admission than those without DM and than IVT-treated patients. No significant differences in stroke severity, hemorrhagic transformation, in-hospital mortality or outcome at 3 months were found. The logistic regression analysis showed that stroke severity was associated with a higher risk of a poor outcome in IVT-treated patients, with no significant effect from DM after adjustment for confounders. Moreover, IVT was independently associated with a lower risk of poor outcome in DM patients (OR 0.49; 95% CI 0.31-0.76; P = .002). DM patients should not be excluded from IVT, because DM is not associated with a poor outcome after IVT and this treatment is clearly beneficial for DM patients as compared with DM patients not treated with IVT.

Diabetes and ischaemic stroke outcome

“…Although not part of our original hypothesis, we found that people with diabetes were significantly less likely to receive tPA treatment than people without diabetes, consistent with findings from other studies [30,31]. A possible explanation for this is that differences in eligibility for tPA treatment existed for those with and without diabetes.…”

“…A possible explanation for this is that differences in eligibility for tPA treatment existed for those with and without diabetes. Alternatively, there may be physician concern about an increased risk of haemorrhage in people with diabetes after tPA treatment [31]; however, it has been shown that tPA improves outcomes in people with diabetes [30]. Therefore, improving thrombolytic treatment in eligible people with diabetes who experience stroke should be a priority.…”

The telestroke and thrombolysis therapy in diabetic stroke patients

“…Thrombolysis is known to produce better outcomes in stroke patients when compared with diabetic stroke patients [6], and clinical trials [10] did not suggest the withholding of thrombolysis therapy from diabetic stroke patients [11]. Moreover, existing studies suggest that the lower rate of thrombolysis therapy in diabetic stroke patients does not appear to be related to contraindications for thrombolysis because a comparison of contraindications for thrombolysis between ischemic stroke patients with and without diabetes did not reveal a significant difference [12].…”

Impact of diabetes on clinical and safety outcomes in acute ischemic stroke patients receiving reperfusion therapy: A meta-analysis

“…44 This highlights the need for comprehensive and tailored management of patients with diabetes during the pandemic and beyond, 43 as well as in stroke patients with pre-existing diabetes who are at risk of poor outcomes after AIS. [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]…”