Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

M.D., M.P.H. William E. Reynolds; Blum, Brice; Brechtel, Leanne; Gainey, Jordan; Nathaniel, Thomas I.

doi:10.4172/1939-067x.1000151

Cited by 5 publications

(6 citation statements)

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“…[ 62 ] The aforementioned factors could result in a lower adherence to treatment in women, and this is supported by another study. [ 63 ] While sex-specific differences in the pharmacokinetics and pharmacodynamics of drugs are not very clear, [ 59 , 64 ] it is also possible that the higher total cholesterol could be attributed to worse lipid profiles reported in women compared with men, [ 65 , 66 ] and therefore disparities in demographic and clinical risk factors could also result in a gender-specific higher total cholesterol in AIS. Therefore, a prompt initiation of tailored prevention strategies to reduce a gender-specific higher total cholesterol in ischemic stroke patients.…”

Section: Discussionmentioning

confidence: 99%

Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

et al. 2020

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Men and women differ in their clinical risk factors with respect to various predictors of severity in acute ischemic stroke (AIS). High cholesterol is a risk factor for AIS and the mechanism by which high cholesterol levels lead to an AIS is well established. However, the specific relationship between demographic, clinical risk factors, total cholesterol, and the resulting gender difference in AIS patients is yet to be investigated. This study recruited AIS patients between January 2000 and June 2016 classified into normal, borderline or high total cholesterol (TC). Normal was defined as ≤200 mg/dl, borderline 200 to 239 mg/dl and high ≥240 mg/dl based on Adult Treatment Panel III (ATP III) Guidelines for the classification of TC levels. The logistic regression model was used to predict clinical risk factors associated within men and women AIS patients with different levels of TC. A total of 3532 AIS patients presented with normal TC, 760 patients with borderline TC and 427 patients with high TC. The high total cholesterol group was more likely to be women with increasing age (OR = 1.028, 95% CI, 1.006–1.052, P = .014), body mass index (BMI) (OR = 1.052, 95% CI, 1.004–1.102, P = .033), and high-density lipoprotein cholesterol (HDL-C) (OR = 1.039, 95% CI, 1.019–1.060, P < .001), while those with coronary artery disease (OR = 0.435, 95% CI, 0.234–0.809, P = .003), history of drug or alcohol abuse (OR = 0.261, 95% CI, 0.079–0.867, P = .028), increasing INR (OR = 0.187, 95% CI, 0.047–0.748, P = .018), and elevated diastolic blood pressure (OR = 0.982, 95% CI, 0.970–0.995, P = .006) were associated with being a male AIS patient. There were disparities in demographic and clinical risk factors associated with high TC levels in men when compared to women and more clinical risk factors were associated with high TC levels in men when compared to women with AIS. It is important to take into account specific clinical risk factors associated with gender-related differences in total cholesterol in AIS population to facilitate personalizing their therapeutic actions.

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Section: Discussionmentioning

confidence: 99%

Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

et al. 2020

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“…Our finding of a strong association of telestroke with thrombolysis may reflect the fast response for the early recommendation of administration of rtPA in the hub station and faster administration in the spoke station resulting in significant increases in the rates of rtPA utilization at the spoke hospitals. There is a growing evidence that telemedicine services offer hypertensive patients the access to diagnostic measures [41, 44] that might not be available with usual bedside evaluation care. This indicates that telemedicine has the ability to deconstruct the typical traditional model in the standard clinical consultation [29].…”

Section: Discussionmentioning

confidence: 99%

“…All data including neuroimaging data were reviewed by a clinician, who determined whether the patient met the clinical case description of acute stroke. The events were categorized as ischemic stroke, transient ischemic attack, intracerebral hemorrhage, or subarachnoid hemorrhage according to descriptions of stroke from the Classification of Cerebrovascular Diseases III [41]. Patients with missing brain imaging data or no information for times of receiving rtPA, and stroke patients with incidence hypertension without medical records were all excluded.…”

Section: Introductionmentioning

confidence: 99%

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

et al. 2018

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BackgroundIn acute ischemic stroke patients, telestroke technology provides sustainable approaches to improve the use of thrombolysis therapy. How this is achieved as it relates to inclusion or exclusion of clinical risk factors for thrombolysis is not fully understood. We investigated this in a population of hypertensive stroke patients.MethodsStructured data from a regional stroke registry that contained telestroke and non telestroke patients with a primary diagnosis of acute ischemic stroke with history of hypertension were collected between January 2014 and June 2016. Clinical risk factors associated with inclusion or exclusion for recombinant tissue plasminogen activator (rtPA) in the telestroke and non telestroke were identified using multiple regression analysis. Associations between variables and rtPA in the regression models were determined using variance inflation factors while the fitness of each model was determined using the ROC curve to predict the power of each logistic regression model.ResultsThe non telestroke admitted more patients (62% vs 38%), when compared with the telestroke. Although the telestroke admitted fewer patients, it excluded 11% and administered thrombolysis therapy to 89% of stroke patients with hypertension. In the non telestroke group, adjusted odd ratios showed significant associations of NIH stroke scale score (OR = 1.059, 95% CI, 1.025–1.093, P < 0.001) and coronary artery disease (OR = 2.003, 95% CI, 1.16–3.457, P = 0.013) with inclusion, while increasing age (OR = 0.979, 95% CI, 0.961–0.996, P = 0.017), higher INR (OR = 0.146, 95% CI, 0.032–0.665, P = 0.013), history of previous stroke (OR = 0.39, 95% CI, 0.223–0.68, P = 0.001), and renal insufficiency (OR = 0.153, 95% CI, 0.046–0.508, P = 0.002) were associated with rtPA exclusion. In the telestroke, only direct admission to the telestroke was associated with rtPA administration, (OR = 4.083, 95% CI, 1.322–12.611, P = 0.014).ConclusionThe direct admission of hypertensive stroke patients to the telestroke network was the only factor associated with inclusion for thrombolysis therapy even after adjustment for baseline variables. The telestroke technology provides less restrictive criteria for clinical risk factors associated with the inclusion of hypertensive stroke patients for thrombolysis.

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“…Patients included in this study presented within 24 h of onset of AIS symptoms, based on relevant lesions demonstrating ischemia or injury on brain magnetic resonance imaging or computed tomography, such as decreased gray/white matter distinction, parenchymal hypodensity, sulcal swelling, or cerebral artery hyperdensity. The stroke registry, previously described in other studies,[ 16 17 18 19 20 21 22 23 24 25 ] provided data on patient demographics, laboratory values, clinical presentation, and medical history. The demographic variables studied include age, race, gender, ethnicity, body mass index (BMI), and medication history on admission.…”

Section: Methodsmentioning

confidence: 99%

Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

et al. 2021

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BACKGROUND: Specific clinical and demographic risk factors may be associated with improving or worsening neurologic outcomes within a population of acute ischemic stroke (AIS) patients with a history of obstructive sleep apnea (OSA). The objective of this study was to determine the changes in neurologic outcome during a 14-day recovery as it relates to initial stroke severity in AIS patients with OSA. METHODS: This retrospective study analyzed baseline clinical risk factors and demographic data collected in a regional stroke center from January 2010 to June 2016. Our primary endpoint measure was the National Institutes of Health Stroke Scale (NIHSS) score and our secondary endpoint measures included the clinical factors associated with improving (NIHSS score ≤7) or worsening (NIHSS score >7) neurological outcome. The relative contribution of each variable to stroke severity and related outcome was determined using a logistic regression. The regression models were checked for the overall correct classification percentage using a Hosmer–Lemeshow test, and the sensitivity of our models was determined by the area under the receiver operating characteristic curve. RESULTS: A total of 5469 AIS patients were identified. Of this, 96.89% did not present with OSA while 3.11% of AIS patients presented with OSA. Adjusted multivariate analysis demonstrated that in the AIS population with OSA, atrial fibrillation (AF) (odds ratio [OR] = 3.36, 95% confidence interval [CI], 1.289–8.762, P = 0.013) and changes in ambulatory status (OR = 2.813, 95% CI, 1.123–7.041, P = 0.027) showed an association with NIHSS score >7 while being Caucasian (OR = 0.214, 95% CI, 0.06–0.767, P = 0.018) was associated with NIHSS score ≤7. CONCLUSION: In AIS patients with OSA, AF and changes in ambulatory status were associated with worsening neurological outcome while Caucasian patients were associated with improving neurological outcome. Our findings may have significant implications for patient stratification when determining treatment protocols with respect to neurologic outcomes in AIS patients with OSA.

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Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

Cited by 5 publications

References 35 publications

Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

Predictors of thrombolysis in the telestroke and non telestroke settings for hypertensive acute ischemic stroke patients

Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

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