Co-morbid conditions in use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischaemic stroke

Nathaniel, Thomas I.; Cochran, Thomas; Chaves, J. M.; Fulmer, Eric; Sosa, Crystal; Yi, Sara; Fredwall, Megan; Sternberg, Shannon; Blackhurst, Dawn W.; Nelson, Alfred D.; Leacock, Rodney O.

doi:10.1080/02699052.2016.1186840

Cited by 37 publications

(29 citation statements)

References 41 publications

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“…It has been shown that specific comorbidities may influence the benefits of thrombolytic therapy in patients with ischemic stroke. [19][20][21][22][23][24][25] In addition, we know that some risk factors for TIA and ischemic stroke including hypertension (HTN), diabetes, and heart diseases 20,[25][26][27][28][29][30][31] may interact with thrombolytic therapy to significantly modulate ambulation and affect treatment outcome. In this case, one possibility is that perhaps specific clinical risk factors in patients with TIA-ischemic stroke may increase the odds of good or poor functional ambulation outcome because of the resulting interactive effect with thrombolytic therapy.…”

Section: Introductionmentioning

confidence: 99%

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

Poupore

Strat

Mackey

et al. 2020

Clin Appl Thromb Hemost

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Background: Specific clinical risk factors linked to transient ischemic attack (TIA) could affect functional ambulatory outcome following thrombolytic therapy in patients having ischemic stroke with a prior TIA (TIA-ischemic stroke). This issue was investigated in this study. Methods: We retrospectively analyzed data from 6379 ischemic stroke patients of which 1387 presented with an antecedent TIA prior to onset of stroke. We used logistic regression model to identify demographic and clinical risk factors that are associated with functional ambulatory outcome in patients with TIA-ischemic stroke treated with thrombolytic therapy. Results: In a population of TIA-ischemic stroke who received recombinant tissue plasminogen activator, patients with a history of stroke (odds ratio [OR] = 3.229, 95% confidence interval [CI] = 1.494-6.98, P = .003) were associated with increasing odds of improvement in functional ambulation, while the female gender (OR = 0.462, 95% CI = 0.223-0.956, P = .037) was associated with reducing odds of improvement. In the non-TIA group, dyslipidemia (OR = 1.351, 95% CI = 1.026-1.781, P = .032) and blood glucose (OR = 1.003, 95% CI = 1.0-1.005, P = .041) were associated with the increasing odds of improvement while older patients (OR = 0.989, 95% CI = 0.98-0.999, P = .029) with heart failure (OR = 0.513, 95% CI = 0.326-0.808, P = .004) and higher lipid level (OR = 0.834, 95% CI = 0.728-0.955, P = .009) were associated with reducing odds of improvement in ambulation. Conclusion: In a population of TIA-ischemic stroke with thrombolytic therapy and a clearly defined TIA without focal ischemic injury, regardless of associated clinical risk factors, a TIA prior to a stroke is not associated with reducing odds of improved ambulatory outcome, except in female patients with TIA-ischemic stroke.

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Section: Introductionmentioning

confidence: 99%

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

Poupore

Strat

Mackey

et al. 2020

Clin Appl Thromb Hemost

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“…Previous TIA is not a formal contraindication for rtPA, especially if the TIA was at least three months before the onset of stroke [28] [22,29]. However, it has been shown that the onset of TIA within 24 hours of stroke may lead to a poor outcome following rtPA [30,31].…”

Section: Discussionmentioning

confidence: 99%

“…Data within the Greenville Health System (GHS) stroke registry has been standardized according to the "Get with The Guidelines" (GWTG) stroke registry formed by the American Heart Association (AHA). Details in the ascertainment and data collection have previously been described [22][23][24]. Briefly, data was collected from 1466 ischemic stroke patients admitted to the stroke Unit of GHS between January 2014 and June 2016 with a diagnosis of acute ischemic stroke.…”

Section: Methodsmentioning

confidence: 99%

Clinical Risk Factors that Predict Functional Recovery in Ischemic Stroke Patients with Pre-Stroke Depression

Wormack¹,

Blum²,

Bailes³

et al. 2019

Preprint

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Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 -104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 -43.529, P=0.019), previous TIA (OR= 0.444, 95% CI, 0.517 -0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 -0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

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“…Data within the Greenville Health System (GHS) stroke registry has been standardized according to the "Get with The Guidelines" (GWTG) stroke registry formed by the American Heart Association (AHA). Details in the ascertainment and data collection have previously been described [22][23][24] Clinical parameters relating to the hospital course included data of stroke patients in the use of rtPA for the 4.5 hours of the protocol. We included data on laboratory analyses of samples including serum lipid panel, LDL, total cholesterol and creatinine levels.…”

Section: Methodsmentioning

confidence: 99%

Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

Wormack¹,

Blum²,

Bailes³

et al. 2019

Preprint

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Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

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Co-morbid conditions in use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute ischaemic stroke

Cited by 37 publications

References 41 publications

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

Clinical Risk Factors that Predict Functional Recovery in Ischemic Stroke Patients with Pre-Stroke Depression

Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

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