Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patient Smokers Treated with Thrombolytic Therapy

Awujoola, Adeola; Sodeke, Patrick Olumuyiwa; Olufeyisayo, Odebunmi; Mokikan, Moboni; Adeyemi, Emmanuel; Babalola, Grace; Awujoola, Oluwatosin; Okon, Marvin; Nathaniel, Thomas I.

doi:10.1016/j.amjms.2021.01.028

Cited by 5 publications

(5 citation statements)

References 54 publications

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“…Our finding that lower INR was associated with a lower stroke severity has been reported by another study [29]. While the use of warfarin, the medication for controlling coagulation by itself, is not an absolute contraindication to recombinant tissue plasminogen activator(rtPA) administration; because of increased bleeding risk, an INR of >1.7 is a contraindication for the use of rtPA for AIS patient [30][31][32][33]. Nevertheless, stroke is reported to occur in patients on warfarin despite anticoagulation [34].…”

Section: Discussionsupporting

confidence: 70%

“…Although smoking is an apparent risk factor for AIS, some studies [31,37,38]have found an association between smokers that receive thrombolytics and improved clinical outcomes. The most common critique of studies that affirm the paradox is their small sample size [39], and most metanalyses find no association between smoking status and stroke severity [40,41].…”

Section: Discussionmentioning

confidence: 99%

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Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

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Background and Purpose. Heart failure (HF) is considered one of the major risk factors associated with the severity of acute ischemic stroke(AIS). The risk factors associated with stroke severity in AIS with a history of HF is not fully understood. Methods. A prospectively maintained database from comprehensive stroke centers in PRISMA Health Upstate Sc, was analyzed for patients with AIS and a history of HF from January 2010 to 30 June 2016. The primary outcome was risk factors associated with a National Institute of Health Stroke Scale score (NIHSS) < 7 indicating lower severity and a score ≥ 7 indicating high severity for 65–74 age category and ≥75 years age category for AIS-HF patients. Univariate analysis was used to determine risk factors based on age categories and stroke severities, while multivariable analysis was used to adjust for the effect of confounding variables. Results: A total 367 AIS-HF patients were identified in this study, 113 patients were between 65–74 years old, while 254 patients were in the ≥75 years old age category. In the adjusted analysis for 65–74 age category, history of smoking (OR = 0.105, 95% Confidence interval (CI): 0.018–0.614, p = 0.012), triglycerides (Odd ratio(OR) = 0.993, 95% (CI): 0.987–0.999, p = 0.019), and International Normalized Ratio (INR) (OR = 0.454, 95% CI: 0.196–1.050, p = 0.045), and direct admission treatment (OR = 0.355, 95% CI: 0.137–0.920, p = 0.033) were associated with a lower stroke severity, elevated heart rate (OR = 1.032, 95% CI: 1.009–1.057, p = 0.007) was associated with a higher stroke severity. For the ≥75 years old age category, previous stroke (OR = 2.297, 95% CI: 1.171–9.852, p = 0.024), peripheral vascular disease (OR = 6.784, 95% CI: 1.242–37.065, p = 0.027), heart rate (OR = 1.035, 95% CI: 1.008–1.063, p = 0.012), and systolic blood pressure (OR = 1.023, 95% CI: 1.005–1.041, p = 0.012) were associated with a higher severe stroke severity. Conclusions: After adjusting for the effect of potential confounders, more risk factors were associated with a high severity of stroke among ≥75 years old compared with 65–74 years old AIS-HF patients. Elevated heart rate was an independent risk factor associated with stroke severity in 65–74 and ≥75 years old AIS-HF patients. Elevated heart rate and other identified risk factors should be managed to reduce stroke severity among elderly AIS-HF patients.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Edrissi

Rathfoot

Knisely

et al. 2022

JCM

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“…Women are more likely to present with hypertension, diabetes mellitus, and obesity [ 12 , 35 ]. In contrast, men are more likely to present with a history of heart disease, myocardial infarction, peripheral arterial disease, current smoking, and alcohol consumption [ 5 , 6 , 36 , 37 ]. Our current study found that women presenting with AIS with increased heart rate treated in the telestroke network were associated with worsening neurologic functions.…”

Section: Discussionmentioning

confidence: 99%

“…Another study found that men are three times more likely to present with improved functional outcomes with rtPA treatment than women [ 4 ]. In general, the observed gender differences have been attributed to several factors such as age [ 5 , 6 ], comorbidity [ 7 , 8 ], prestroke functional status [ 9 , 10 ], and stroke severity [ 7 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network

Poupore

Edrissi

Sowah

et al. 2022

Cerebrovasc Dis Extra

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Introduction. This study investigates gender differences among stroke patients treated in the telestroke network using specific risk factors that contribute to stroke severity. Methods. We examined gender differences in stroke severity among 454 patients hospitalized with acute ischemic stroke (AIS). The logistic regression model was used to predict clinical risk factors associated with stroke severity in men and women AIS patients. Results. In the adjusted analysis, among women patients, increasing age [Odd ratio(OR) = 1.05, 95% CI, 1.017-1.085, P = 0.003], and higher heart rate (OR = 1.031, 95% CI, 1.005-1.058, P=0.021) were associated with worsening neurological functions, while direct admission (OR = 0.191, 95% CI, 0.079‐0.465, P<0.001) was associated with improving neurologic functions. Among men, hypertension (OR = 3.077, 95% CI, 1.060‐8.931, P = 0.039), and higher international normalized ratio (INR) (OR=21.959, 95% CI, 1.489-323.912, P=0.024) were associated with worsening neurologic functions, while Caucasian (OR=0.181, 95% CI, 0.062-0.526, P=0.002) and obesity (OR=0.449, 95% CI, 0.203-0.99, P=0.047) were associated with neurologic improvement. Conclusion. Increasing age and heart rate in women, hypertension and greater INR in men contribute to worsening neurologic functions. There is the need to develop strategies to improve the care of both men and women in the telestroke network.

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“…Despite substantial progress in research focusing on sex differences in comorbidities influencing outcomes in male and female post-stroke patients who smoke [1][2][3], there are still major research gaps in stroke risk factors specific for male and female smokers and obese individuals. While several studies have shown that smoking is not associated with an increase in body weight [4], smoking is known to be associated with central obesity [5,6].…”

Section: Introductionmentioning

confidence: 99%

Sex differences in clinical risk factors in obese ischemic stroke patients with a history of smoking

Ojo,

Brewer,

Imeh-Nathaniel

et al. 2024

BMC Cardiovasc Disord

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Clinical risk factors associated obesity and smoking, as well as their combined effect, are not fully understood. This study aims to determine sex differences in risk factors in a population of acute ischemic stroke (AIS) patients who are obese and with a history of previous or current smoking. Methods A retrospective analysis of risk factors in male and female AIS patients with baseline data of obesity and current or previous history of smoking, smoking, and obesity alone was determined. The primary predictor and outcome are risk factors associated with male and female AIS patients. Baseline risk factors were analyzed using a multivariate regression analysis to determine specific risk factors linked with the combined effect of obesity and current or previous history of smoking’’. Results Male obese AIS patients who are current or previous smokers were more likely to be older patients(OR = 1.024, 95% CI, 1.022–1.047, P = 0.033) that present with coronary artery disease (OR = 1.806, 95% CI, 1.028–3.174, P = 0.040), a history of alcohol use (OR = 2.873, 95% CI, 1.349–6.166, P = 0.006), elevated serum creatinine (OR = 4.724, 95% CI, 2.171–10.281, P < 0.001) and systolic blood pressure (OR = 1.029, 95% CI, 1.011–1.047, P < 0.002). Females were more associated with depression (OR = 0.432, 95% CI, 0.244–0.764, P = 0.004), previous TIA (OR = 0.319, 95% CI, 0.142–0.714, P < 0.005), and higher levels of HDL (OR = 0.938, 95% CI, 0.915–0.962, P < 0.001). Conclusion Our results reveal sex differences in risk factors in obese AIS patients with a current or past history of smoking. This finding emphasizes the need to develop management strategies to improve the care of obese AIS patients who are either current or former smokers.

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Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patient Smokers Treated with Thrombolytic Therapy

Cited by 5 publications

References 54 publications

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Age Stratification in Acute Ischemic Stroke Patients with Heart Failure

Stroke Severity among Men and Women Acute Ischemic Stroke Patients in the Telestroke Network

Sex differences in clinical risk factors in obese ischemic stroke patients with a history of smoking

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