Inverse relationship of baseline body temperature and outcome between ischemic stroke patients treated and not treated with thrombolysis: the Bergen stroke study

Næss, Halvor; Idicula, Titto; Lagallo, N; Brøgger, Jan; Waje‐Andreassen, Ulrike; Thomassen, Lars

doi:10.1111/j.1600-0404.2010.01331.x

Cited by 31 publications

(45 citation statements)

References 19 publications

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“…Significance was lost at temperatures Ͻ35.5°C and Ͼ37.5°C, although point estimates suggest that hyperthermia attenuates thrombolysis-associated benefit. Our data support an association between hyperthermia and poorer outcome 1,4 and support existing guidelines that recommend treatment of pyrexia. 2 In vitro evidence suggests that lower temperatures reduce the rate of fibrinolysis by alteplase, 7 whereas hyperthermic stress may reduce endogenous fibrinolytic capacity.…”

Section: Discussionsupporting

confidence: 75%

“…3 The influence of hypothermia on outcomes after acute stroke is of immense interest, but interpretation is confounded by contradictory data from experimental models and human studies. 4,5 To examine the influence of temperature on outcomes after thrombolytic therapy, we analyzed clinical data held within the Virtual International Stroke Trials Archive (VISTA). 6 We report outcomes for various levels of baseline body temperature by comparing patients who received alteplase with those who did not.…”

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confidence: 99%

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Low Body Temperature Does Not Compromise the Treatment Effect of Alteplase

Lees

Mishra²,

Saini³

et al. 2011

Stroke

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Background and Purpose-Hypothermia is neuroprotective in ischemic stroke models. The influence of baseline body temperature on outcomes after thrombolytic therapy is unclear. We examined outcomes after alteplase treatment across baseline body temperature for patients with ischemic stroke in data held within the Virtual International Stroke Trials Archive (VISTA; 1998 to 2007). Methods-We collated data on age, baseline severity (National Institutes of Health Stroke Scale), and 90-day modified Rankin Scale score on patients presenting with acute ischemic stroke. We compared 90-day modified Rankin Scale score between thrombolyzed and nonthrombolyzed comparators across baseline body temperature. We report age and baseline National Institutes of Health Stroke Scale-adjusted Cochran-Mantel-Haenszel probability value and proportional OR with 95% CI for improved modified Rankin Scale distribution. We report temperature profiles over 72 hours after stroke by treatment group. Results-Rankin data were available for 5586 patients with acute ischemic stroke in VISTA (1980 received alteplase). Age and baseline severity were similar (age 68.0Ϯ13.0 years versus 69.9Ϯ12.3 years, National Institutes of Health Stroke Scale 14.2Ϯ5.2 versus 13.0Ϯ5.6). Alteplase was associated with improved outcome (OR, 1.49; 95% CI, 1.35 to 1.65, PϽ0.0001). Alteplase treatment effect was not associated with baseline temperature (Pϭ0.14). Point estimates showed benefit of alteplase treatment across 35.5°C to 37.5°C but showed a negative trend Ͼ37.5°C. Alteplase did not influence temperature profiles over 72 hours after stroke. Conclusions-There is no evidence of influence of body temperature on alteplase treatment response. These results are reassuring that low temperatures across a physiological range do not compromise therapeutic effect of alteplase. (Stroke. 2011;42:2618-2621.)

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Section: Discussionsupporting

confidence: 75%

mentioning

confidence: 99%

Low Body Temperature Does Not Compromise the Treatment Effect of Alteplase

Lees

Mishra²,

Saini³

et al. 2011

Stroke

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“…Nevertheless, the response to recombinant tissue plasminogen activator is reduced in hypothermia. 7) In this case, the principal purpose of therapeutic hypothermia is ICP control. To the best of our knowledge, therapeutic hypothermia has been induced in only one patient with hemorrhagic moyamoya disease for the prevention of ischemic complications.…”

Section: Discussionmentioning

confidence: 99%

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

Shibamoto¹,

Aoyama²,

Taki³

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 31-year-old male presenting with intracranial hemorrhage manifesting as deep coma and anisocoria underwent immediate emergency surgery. Three-dimensional computed tomography (CT) angiography revealed stenosis of the right middle cerebral artery (MCA) and perfusion CT immediately after the surgery suggested severe hypoperfusion in the right MCA territory. Postoperative angiography demonstrated right unilateral moyamoya disease. We predicted that brain edema and intracranial pressure (ICP) elevation occurring after the hemorrhage might result in cerebral infarction. Hyperosmotic drugs were contraindicated by dehydration. Therefore, therapeutic hypothermia was induced that controlled the ICP. We considered that the increased ICP, dehydration, vasospasm, and shrinkage of the ruptured vessel comprised the pathogenesis of acute cerebral ischemia after intracranial bleeding. Cerebral hemodynamics should be evaluated during the acute phase of cerebral hemorrhage to prevent subsequent cerebral infarction.

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“…Previous studies have shown that body temperature elevation is associated with the clinical severity and prognosis of stroke (12)(13)(14). Elevated body temperature is also a risk factor for the hemorrhagic transformation of acute ischemic stroke when recombinant tissue-type plasminogen activator treatment is not applied to patients (15).…”

Section: A B Cmentioning

confidence: 99%

Reduction of the systemic inflammatory induced by acute cerebral infarction through ultra-early thrombolytic therapy

Ruowei

Yang

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. Acute ischemic stroke induces systemic inflammation, exhibited as changes in body temperature, white blood cell counts and C-reactive protein (CRP) levels. The aim of the present study was to observe the effects of intravenous thrombolytic therapy on inflammatory indices in order to investigate the hypothesis that post-stroke systemic inflammatory response occurs in response to the necrosis of brain tissues. In this study, 62 patients with acute cerebral infarction and indications for intravenous thrombolysis were divided into three groups on the basis of their treatment and response: Successful thrombolysis (n=36), failed thrombolysis (n=12) and control (n=14) groups. The body temperature, white blood cell counts and highsensitivity (hs)-CRP levels were recorded pre-treatment and on post-stroke days 1, 3, 5 and 7. Spearman's correlation analysis showed that the pre-treatment National Institutes of Health Stroke Scale (NIHSS) score positively correlated with body temperature, white blood cell count and hs-CRP levels. On day 3 of effective intravenous thrombolysis, the body temperature and white blood cell were decreased and on days 3 and 5, the serum levels of hs-CRP were reduced compared with those in the failed thrombolysis and control groups. The results indicate that the systemic inflammatory response following acute cerebral infarction was mainly caused by ischemic injury of local brain tissue; the more serious the stroke, the stronger the inflammatory response. Ultra-early thrombolytic therapy may inhibit the necrosis of brain tissue and thereby reduce the inflammatory response.

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Inverse relationship of baseline body temperature and outcome between ischemic stroke patients treated and not treated with thrombolysis: the Bergen stroke study

Abstract: Our study suggests that the effect of high body temperature on clot lysis is more important than the neuroprotective effect of low body temperature in the early phase after cerebral infarction treated with tPA.

Cited by 31 publications

References 19 publications

Low Body Temperature Does Not Compromise the Treatment Effect of Alteplase

Low Body Temperature Does Not Compromise the Treatment Effect of Alteplase

Acute Cerebral Ischemia After Intracranial Bleeding in Unilateral Moyamoya Disease

Reduction of the systemic inflammatory induced by acute cerebral infarction through ultra-early thrombolytic therapy

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