Functional Outcome Measures of Recombinant Tissue Plasminogen Activator–Treated Stroke Patients in the Telestroke Technology

Gainey, Jordan; Brecthtel, Leanne; Blum, Brice; Keels, Aaliyah; Madeline, Lee; Lowther, Ervin; Nathaniel, Thomas I.

doi:10.1177/1179069518793412

Cited by 25 publications

(16 citation statements)

References 45 publications

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“…Despite this well‐established connection between obesity and stroke risk, several clinical studies indicate that obese ischemic stroke patients have improved mortality and morbidity. For example, increased BMI is directly linked with improved outcomes in post‐stroke treatment with rtPA, including a reduced risk of recurrent stroke, 17,25,26 morbidity, 23 and improved functional recovery 7,27,28 . These findings support our current result of inclusion of obese TIA‐ischemic stroke patients for rtPA.…”

Section: Discussionsupporting

confidence: 77%

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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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: Discussionsupporting

confidence: 77%

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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“…The absence of pre‐stroke functional status (ie, pre‐stroke mRS) and post‐treatment NIH scores did not allow for pre‐ and post‐stroke comparison for ambulatory and NIH scores or mRS to be made. Ambulation as a tool for functional outcome in ischemic stroke has been validated. In general, untreated hypertension in the acute stage of ischemic stroke may be associated with poor functional outcome.…”

Section: Discussionmentioning

confidence: 99%

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Fleming

Blum

Averkamp

et al. 2019

J of Clinical Hypertension

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There are concerns that specific risk factors may alter the benefits of thrombolysis in stroke patients with controlled contraindications including hypertension. The objective of this study was to evaluate the association between clinical risk factors and outcomes in ischemic stroke patients that received thrombolysis therapy pretreated with antihypertensive medications. Using data obtained from a stroke registry, a non‐randomized retrospective data analysis was conducted on patients with the primary diagnosis of acute ischemic stroke with hypertension pretreated with antihypertensive medications. The association between clinical risk factors and functional ambulatory outcome was determined using logistic regression while odd ratios (OR) were used to predict the odds of achieving improved ambulatory outcome in thrombolysis treatment status. Improved or poor functional ambulatory outcome was considered as the end point in our analysis. A total of 4665 acute ischemic stroke patients were identified, of whom 1446 (31.0%) were eligible for thrombolysis, while 3219 were not, and 595 received rtPA, of whom 288 were on antihypertensive medications, while 233 were not. In the rtPA group with antihypertensive (anti‐HTN) medication, only NIHSS score (OR = 1.094, 95% CI, 1.094‐1.000, P = 0.005) was associated with improved functional outcome while patients with congestive heart failure (OR = 0.385, 95% CI, 0.385‐0.159, P = 0.035) and patients with a history of previous TIA (OR = 0.302, 95% CI, 0.302‐0.113, P = 0.017) were more likely to be associated with poor functional outcomes. Congestive heart failure and TIA are independent predictors of functional outcomes in stroke patients pretreated with antihypertensive medications prior to thrombolysis therapy.

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“…The GHS stroke registry contributes to Get with The Guidelines (GWTG)–Stroke, a national registry of the American Heart Association and American Stroke Association. The GHS registry has been described in previous studies [13, 18, 39–43]. All data including neuroimaging data were reviewed by a clinician, who determined whether the patient met the clinical case description of acute stroke.…”

Section: Methodsmentioning

confidence: 99%

Gender and thrombolysis therapy in stroke patients with incidence of dyslipidemia

et al. 2019

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BackgroundWhen untreated, dyslipidemia is a higher risk factor for stroke and stroke-related mortality in men than in women. However, when dyslipidemia is treated the risk reduction is the same, but men benefited from mortality reduction more than women. Whether there is a gender difference in exclusion criteria for the use of recombinant tissue plasminogen activator (rtPA) or thrombolysis therapy in an acute ischemic stroke subpopulation with dyslipidemia is yet to be investigated.MethodIn a dyslipidemic stroke population obtained from a stroke registry, gender differences in exclusion risk factors were determined using clinical and demographic variables. Univariate analysis compared the recombinant tissue plasminogen activator (rtPA) group and the no rtPA group. Multiple regression analysis was used to determine demographic and clinical factors associated with inclusion and exclusion for rtPA in the total dyslipidemic stroke population and the subsets of the male and female population. The regression model was tested using the Hosmer-Lemeshow test, for the overall correct classification percentage. Significant interactions and multicollinearity between independent variables were examined using variance inflation factors.ResultsA total of 769 patients presented with acute ischemic stroke with incidence dyslipidemia; 325 received rtPA while 444 were excluded from rtPA. Of those excluded from rtPA, 54.30% were female and 45.72% were male. In an adjusted analysis, female patients with increased age (OR = 1.024, 95% CI, 1.001–1.047, P < 0.05), with a history of carotid artery stenosis (OR = 7.063, 95% CI, 1.506–33.134, P < 0.05), and previous stroke (OR = 1.978, 95% CI, 1.136–3.442, P < 0.05) were more likely to be excluded from rtPA. Male patients with atrial fibrillation (OR = 2.053, 95% CI, 1.059–3.978, P = 0.033), carotid artery stenosis (OR = 2.400, 95% CI, 1.062–5.424, P = 0.035), and previous stroke (OR = 1.785, 95% CI, 1.063–2.998, P = 0.028) were more likely to be excluded from rtPA.ConclusionAlthough there are some similarities in the clinical risk factors for exclusion in both male and female stroke patients with incidence of dyslipidemia, there are differences as well. Elderly female stroke patients with incidence of dyslipidemia are more likely to be excluded from rtPA, even after adjustment for the effect of confounding variables. Further research should focus on how identified clinical risk factors can be targeted and managed to improve the use of rtPA in elderly female acute ischemic stroke population with incidence of dyslipidemia.

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Functional Outcome Measures of Recombinant Tissue Plasminogen Activator–Treated Stroke Patients in the Telestroke Technology

Cited by 25 publications

References 45 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

Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

Gender and thrombolysis therapy in stroke patients with incidence of dyslipidemia

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