Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Muchada, Marián; Rubiera, Marta; Rodríguez‐Luna, David; Pagola, Jorge; Flores, Alan; Kallas, Julia; Sanjuan, Estela; Meler, Pilar; Alvarez-Sabin, José; Ribó, Marc; Molina, Carlos A.

doi:10.1161/strokeaha.113.004307

Cited by 60 publications

(32 citation statements)

References 25 publications

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“…This retrospective study was performed on consecutive patients admitted for acute ischemic stroke in Dongguan People's Hospital between January 2016 and December 2017. The inclusion criteria were as follows: (a) first‐ever acute ischemic stroke within 24 hr after symptom onset; (b) 18–80 years of age; (c) mild or moderate stroke on admission assessed by a National Institutes of Health Stroke Scale (NIHSS) score ≤14 (Lindsell et al, ; Muchada et al, ); and (d) length of in‐hospital stay ≥3 days. The exclusion criteria were as follows: (a) hemorrhagic stroke identified by admission computed tomography (CT) scan; (b) administration of intravenous thrombolysis or/and intra‐arterial thrombectomy treatment; (c) history of anticoagulant drug use at least 7 days prior to admission; (d) coexisting severe systemic diseases, including cancer, chronic obstructive pulmonary disease, gastrointestinal bleeding, or chronic renal insufficiency (creatinine > 2 mg/dl or requiring dialysis).…”

Section: Methodsmentioning

confidence: 99%

Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation

et al. 2019

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Objective Dehydration is a risk factor for early neurological deterioration (END) after ischemic stroke, yet the underlying mechanism is unclear. Outbalanced coagulation activation may contribute to ischemia progression, concurrently with dehydration‐induced blood viscosity change. We aimed to investigate whether the contribution of dehydration to END was mediated by blood coagulation activation. Methods We retrospectively evaluated consecutive patients presenting with mild or moderate stroke (National Institutes of Health Stroke Scale score ≤14) within 24 hr of onset between Jan 2016 and Dec 2017. Dehydration was defined by a serum nitrogen to creatinine ratio (BUN/Cr) of ≥15 and blood coagulation activity was assessed with thromboelastography (TEG). The correlations between BUN/Cr and TEG parameters were assessed and their relationship in the development of END was analyzed. Results Of 244 patients, 64 (26.2%) developed END within 3 days after admission. Patients with END had significantly higher BUN/Cr (19.2 ± 5.7 vs. 15.3 ± 2.9, p = 0.008), shorter R and K on TEG test (R: 3.9 ± 1.0 vs. 4.6 ± 1.1, p = 0.001; K: 1.3 ± 0.5 vs. 1.5 ± 0.4, p = 0.005). Comparison between patients with and without dehydration revealed no significant differences in TEG parameters. Multivariate regression suggested that dehydration status (OR 3.91, 95%CI 2.17–8.67, p = 0.008) and shorter R tercile on TEG (OR 3.18, 95% CI 1.23–7.90, p = 0.016) were independently associated with END; however, the odds ratio of R for END remained unchanged after adjustment for dehydration status. Conclusion Our findings suggested that the contribution of dehydration to END after ischemic stroke was mediated by blood coagulation activation.

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Section: Methodsmentioning

confidence: 99%

Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation

et al. 2019

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“…The severity are mostly defined as mild in <5 or 6, severe in >14 or 15 [22, 23], or ≥10 as severe stroke [24]. The latest definition of National Institutes of Health Stroke Scale (NIHSS) severity is mild NIHSS (≤8), moderate NIHSS (9–15), and severe stroke NIHSS (≥16) [25]. According to the literature, we could easily evaluated more than 60% of non-RT stroke patients are total dependency (Barthel Index defined as “total” dependency in ≤20) [21], and more than 70% of non-RT stroke patients are moderate to severe stroke.…”

Section: Discussionmentioning

confidence: 99%

The Relationship between Ischemic Stroke Patients with and without Retroflex Tongue: A Retrospective Study

Huang

Sun

Hsu

et al. 2017

Evidence-Based Complementary and Alternative Medicine

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Background. Patients suffering from stroke exhibit different levels of capability in retroflex tongues, in our clinical observation. This study aims to derive the association of tongue retroflexibility with the degree of severity for stroke patients. Methods. All ischemic stroke patients were collected from August 2010 to July 2013 in the Stroke Center, Changhua Christian Hospital, Taiwan. All participants underwent medical history collection and clinical examination, including tongue images captured by ATDS. Statistical analysis was performed to compare the differences of ischemic stroke patients with and without retroflex tongue. Result. Among the total of 308 cases collected, 123 patients cannot retroflex their tongues, that is, the non-RT group. The length of stay in the non-RT group, 32.0 ± 21.5, was longer than those of the RT counterparts, 25.9 ± 14.4 (p value: 0.007). The NIHSS on admission, 14.1 ± 7.8 versus 8.9 ± 5.2, was higher and the Barthel Index upon admission, 18.6 ± 20.7 and 35.0 ± 24.2, was lower for the non-RT patients than that of the RT counterparts. Also, the non-RT patients account for 60.2% and 75.6% for Barthel Index ≤ 17 and NIHSS ≥ 9, respectively. Conclusion. The stroke patients in non-RT group showed significantly poor prognosis and were more serious in the degree of severity and level of autonomy than RT group, indicating that the ability to maneuver tongue retroflex can serve as a simple, reliable, and noninvasive means for the prognosis of ischemic stroke patients.

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“…Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) score on hospital admission, and trichotomized into three levels (1, NIHSS < 9; 2, NIHSS 9-15; 3, NIHSS > 15) 17 . We classified stroke subtypes according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification 18 .…”

Section: Data Collection and Definitionsmentioning

confidence: 99%

Statin treatment can reduce incidence of early seizure in acute ischemic stroke: A propensity score analysis

Matsubara

Tomari

Fukuma

et al. 2020

Sci Rep

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A previous study showed early statin administration in patients with acute ischemic stroke (AiS) was associated with a lower risk of early-onset seizure (ES), which is a high risk of epilepsy, but this retrospective study design may not have eliminated confounding factor effects. We aimed to verify the determinants and prognostic significance of ES and clarify the effects of statin administration. Consecutive AIS patients without a history of epilepsy were enrolled. The relationship between ES (within 7 days of index-stroke) and statin treatment was assessed using multivariate and propensity scores (PS). Of 2,969 patients with AIS, 1,623 (54.6%) were treated with statin, and 66 (2.2%) developed ES. In logistic regression models, cortical stroke lesion [odds ratio (OR), 2.82; 95% confidence interval (CI), 1.29-7.28) and pre-morbid modified Rankin Scale (per 1 point) (OR, 1.39; 95% CI, 1.18-1.65) were higher risks for ES, while statin significantly reduced the risk of ES (OR, 0.44; 95% CI, 0.24-0.79). In accordance with PS-matching, statin treatment produced consistent results for ES after adjusting by inverse probability of treatment-weighting PS (OR, 0.41; 95% CI, 0.22-0.75). In conclusion, as previously, statin treatment was independently associated with a lower risk of ES in AIS.

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Baseline National Institutes of Health Stroke Scale–Adjusted Time Window for Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke

Cited by 60 publications

References 25 publications

Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation

Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation

The Relationship between Ischemic Stroke Patients with and without Retroflex Tongue: A Retrospective Study

Statin treatment can reduce incidence of early seizure in acute ischemic stroke: A propensity score analysis

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