IV thrombolysis and statins

Engelter, Stefan T.; Soinne, Lauri; Ringleb, Peter A.; Sarıkaya, Hakan; Bordet, Régis; Berrouschot, Jörg; Odier, Céline; Arnold, Marcel; Ford, Gary A.; Pezzini, Alessandro; Zini, Andrea; Rantanen, Kirsi; Rocco, Andrea; Bonati, Leo H.; Kellert, Lars; Strbian, Daniel; Stoll, Anett; Meier, Niklaus; Michel, Patrik; Baumgartner, Ralf W.; Leys, Didier; Tatlısumak, Turgut; Lyrer, Philippe

doi:10.1212/wnl.0b013e31822c9135

Cited by 67 publications

(103 citation statements)

References 27 publications

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“…13,14 Local study investigators completed the forms systematically using prospectively ascertained in-hospital IV ischemic stroke thrombolysis registries. Completed forms from all centers were compiled in the coordinating center Basel, where the analysis of the pooled data was performed, as described previously.…”

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confidence: 99%

“…Completed forms from all centers were compiled in the coordinating center Basel, where the analysis of the pooled data was performed, as described previously. 13,14 The following prospectively ascertained variables were used: age, sex, initial stroke severity as assessed using the NIH Stroke Scale (NIHSS), 15 blood pressure before IVT, onset to treatment, initial serum creatinine (SCr) and glucose values in blood serum, etiology according to the TOAST (Trial of Org 10172 in Acute Stroke Treatment) criteria, 16 and vascular risk factors according to predefined criteria. 17 Post hoc, we added prior treatment with antithrombotic agents (antiplatelet agents and anticoagulants).…”

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confidence: 99%

“…There was monitoring for ICH by follow-up CT or MRI as done in prior research. 14 Each center reported on the period for which they had prospectively collected data on consecutive patients up to December 31, 2011 (table e-1 on the Neurology ® Web site at www. neurology.org).…”

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IV thrombolysis and renal function

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IV thrombolysis and renal function

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“…11,12 Two large observational studies reported that previous treatment with statin was not an independent predictor of functional outcome or of ICH. 13,14 The aim of the THRombolysis and STatins (THRaST) study was to assess the impact of statin use in the acute phase of ischemic stroke on clinical outcome in patients treated with IV thrombolysis.Authors' affiliations are listed at the end of the article. Go to Neurology.org for full disclosures.…”

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“…The long-term efficacy endpoints were favorable functional outcome (mRS # 2) 16 and excellent functional outcome (mRS # 1) 13 at 3 months. The short-term safety endpoints were neurologic deterioration (NIHSS $4 points from baseline or death) 19 at 7 days and sICH (local or remote parenchymal hematoma type 2 on the imaging scan obtained 22 to 36 hours after treatment, with NIHSS score increase of $4 points from baseline or the lowest value in the first 24 hours or leading to death).…”

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The THRombolysis and STatins (THRaST) study

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Bovi²,

Moretto³

et al. 2013

Neurology

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Objective: To assess the impact on stroke outcome of statin use in the acute phase after IV thrombolysis.Methods: Multicenter study on prospectively collected data of 2,072 stroke patients treated with IV thrombolysis. Outcome measures of efficacy were neurologic improvement (NIH Stroke Scale [NIHSS] # 4 points from baseline or NIHSS 5 0) and major neurologic improvement (NIHSS # 8 points from baseline or NIHSS 5 0) at 7 days and favorable (modified Rankin Scale [mRS] # 2) and excellent functional outcome (mRS # 1) at 3 months. Outcome measures of safety were 7-day neurologic deterioration (NIHSS $ 4 points from baseline or death), symptomatic intracerebral hemorrhage type 2 with NIHSS $ 4 points from baseline or death within 36 hours, and 3-month death. Statins are recommended for primary and secondary stroke prevention in patients at risk of cerebrovascular events. Results1 In addition to reducing the risk of first and recurrent ischemic stroke, statin treatment may also improve outcome through pleiotropic non-cholesterol-dependent effects. 2An association between statin use before stroke and favorable outcome has been previously reported.3-5 Moreover, a prospective clinical trial showed that statin withdrawal during the first 3 days after a stroke event was associated with increased risk of death or dependency at 3 months. 6 To date, very few studies have investigated the effect of statin use in the acute phase on ischemic stroke outcome.7-9 The Stroke Prevention with Aggressive Reductions in Cholesterol Levels (SPARCL) trial showed a trend toward less severity for outcome 90 days after stroke with atorvastatin administration (80 mg), compared with placebo, in patients having a stroke during the trial. 10So far, few studies have assessed the efficacy and safety of statin treatment in ischemic stroke patients treated with IV thrombolysis. Two recent meta-analyses showed that prior statin use may increase the risk of symptomatic intracerebral hemorrhage (sICH) within 36 hours after IV recombinant tissue plasminogen activator (rtPA), though without influencing 3-month functional outcome. 11,12 Two large observational studies reported that previous treatment with statin was not an independent predictor of functional outcome or of ICH. 13,14 The aim of the THRombolysis and STatins (THRaST) study was to assess the impact of statin use in the acute phase of ischemic stroke on clinical outcome in patients treated with IV thrombolysis.Authors' affiliations are listed at the end of the article. Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

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Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis

et al. 2015

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IMPORTANCE Mild strokes have been poorly represented in thrombolytic trials and only a few series have reported outcomes after treatment with intravenous (IV) recombinant tissue plasminogen activator (rtPA) after mild stroke. OBJECTIVE To report treatment complications and short-term outcomes in patients with mild stroke who have received treatment with IV rtPA. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of patients treated in the emergency department of hospitals that use the Get With the Guidelines-Stroke registry, a prospectively collected quality improvement registry used by hospitals across the United States. Patients were those admitted between May 1, 2010, and October 1, 2012, with acute ischemic stroke within 4.5 hours from symptom onset and a baseline National Institutes of Health Stroke Scale score of 5 or less. Univariable and multivariable analyses were performed to identify factors independently associated with discharge outcomes and treatment complications. INTERVENTION Intravenous rtPA. MAIN OUTCOMES AND MEASURESTreatment complications included symptomatic intracranial hemorrhage, life-threatening or serious systemic hemorrhage, other serious complications, and undetermined complications. The short-term outcomes analyzed were in-hospital mortality, discharge to home, independent ambulation at discharge, and length of stay. RESULTS Among 33 995 patients who arrived within 4.5 hours of symptom onset and were treated with IV rtPA, 7621 (22.4%) had a National Institutes of Health Stroke Scale score of 5 or less and 5910 had complete data for analysis. Treatment complications were infrequent: symptomatic intracranial hemorrhage, 1.8%; life-threatening or serious systemic hemorrhage, 0.2%; other serious complications, 1.8%; and complications of undetermined cause, 2.4%. Mortality was low (1.3%), but at discharge 30.3% could not ambulate independently, 29.4% could not go directly home, and 73.0% had a length of stay of 3 days or longer. Worse short-term outcomes were seen in older patients, African American patients, diabetic patients, and those who arrived by ambulance, after hours, or with a higher National Institutes of Health Stroke Scale score. CONCLUSIONS AND RELEVANCEMany patients with ischemic stroke treated with IV rtPA have a mild stroke. Symptomatic intracranial hemorrhage is infrequent, but approximately 30% of these patients are unable to return directly home or ambulate independently at discharge. Additional studies are needed to identify strategies to improve the outcomes in patients with mild stroke who receive thrombolysis.

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IV thrombolysis and statins

Abstract: In stroke patients receiving IVT, prior statin use was neither an independent predictor of functional outcome nor ICH. It may be considered as an indicator of baseline characteristics that are associated with a less favorable course.

Cited by 67 publications

References 27 publications

IV thrombolysis and renal function

IV thrombolysis and renal function

The THRombolysis and STatins (THRaST) study

Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis

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