Contraindications with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke population

Polk, Shuler R.; Stafford, C. T.; Adkins, Alyssa; Efird, Jessica; Colello, Michael; Nathaniel, Thomas I.

doi:10.1016/j.npbr.2017.11.002

Cited by 10 publications

(7 citation statements)

References 20 publications

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“…This finding indicates that NIHSS is a strong predictor of stroke severity, 21,22 especially the non-telestroke TIA-ischemic stroke population treated with rtPA. Clinical evidence suggests that reperfusion of cerebral arteries after rtPA is reduced in obese stroke patients, suggesting a reduced effectiveness of rtPA.…”

Section: Discussionmentioning

confidence: 83%

“…The average NIHSS among TIA‐ischemic stroke population with rtPA in the non‐telestroke was generally higher, indicating more severity when compared with TIA‐ischemic stroke population in the telestroke group treated with rtPA. This finding indicates that NIHSS is a strong predictor of stroke severity, 21,22 especially the non‐telestroke TIA‐ischemic stroke population treated with rtPA. Clinical evidence suggests that reperfusion of cerebral arteries after rtPA is reduced in obese stroke patients, suggesting a reduced effectiveness of rtPA 23,24 .…”

Section: Discussionmentioning

confidence: 93%

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Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings

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Strat

Mackey

et al. 2020

Neurology & Clinical Neurosc

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Background This study investigates the risk factors associated with exclusion or inclusion for thrombolytic therapy in TIA‐ischemic stroke patients in a telestroke compared with a non‐telestroke setting. Methods This study retrospectively analyzes regional stroke data collected between January 2010 and June 2016 from TIA‐ischemic stroke patients. We used the logistic regression model to predict clinical risk factors associated with exclusion or inclusion for thrombolytic therapy in the telestroke and non‐telestroke setting. Results This study identified a total of 299 ischemic stroke patients with a history of TIAs. Of these, 98 patients received treatment in a telestroke setting, while 201 received treatment in a non‐telestroke setting. The telestroke excluded fewer patients (58%) and administered thrombolytic therapy to 42% of TIA‐ischemic stroke patients. The non‐telestroke setting excluded 89% of patients, while only 11% of TIA‐ischemic stroke patients received rtPA. In the telestroke setting, a history of previous TIA > 24 hours (OR = 16.014, 95% CI, 4.112‐62.368, P < .001) was associated with rtPA inclusion, while higher blood glucose levels (OR = 0.984, 95% CI, 0.969‐0.999, P = .042) were associated with an rtPA exclusion. Conclusion After adjusting for the effect of confounding variables, we found direct admission to be significant for exclusion in the non‐telestroke setting. Moreover, there was a significant association between hyperglycemia and exclusion from thrombolytic therapy in TIA‐ischemic stroke patients in the telestroke setting.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 93%

Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings

Poupore

Strat

Mackey

et al. 2020

Neurology & Clinical Neurosc

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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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“…Whether such a centralized role of the telestroke contributes to the reduction in pretreatment clinical risk factors associated with thrombolysis therapy is not very clear. Irrespective of whether the stroke patient is treated in the telestroke or non telestroke, hypertension is the most influential adjustable variable and the second most powerful clinical risk factor after age for stroke [15, 19–21]. Hypertensive patients are 60–70% more likely to suffer a stroke when compared to those without hypertension [22–25].…”

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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Contraindications with recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke population

Cited by 10 publications

References 20 publications

Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings

Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings

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

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