Pharmacological thrombolysis for acute ischemic stroke treatment: Gender differences in clinical risk factors

Colello, Michael; Ivey, Lauren E.; Gainey, Jordan; Faulkner, Rakiya V.; Johnson, Ashleigh; Brechtel, Leanne; Madeline, Lee; Nathaniel, Thomas I.

doi:10.1016/j.advms.2017.08.003

Cited by 26 publications

(23 citation statements)

References 43 publications

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“…History of previous stroke represents an exclusion criteria, especially in patients with large infarctions and concern of bleeding [37]. Furthermore, high levels of serum creatinine as an exclusion criteria is due to risk of symptomatic intracranial hemorrhage [38], while elevated INR is due to the risk of intracranial hemorrhage [39].…”

Section: Discussionmentioning

confidence: 99%

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Poupore

Strat

Mackey

et al. 2019

Preprint

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Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

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Section: Discussionmentioning

confidence: 99%

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Poupore

Strat

Mackey

et al. 2019

Preprint

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“…Our analysis was conducted on anonymous subjects using retrospective data from a regional stroke center's registry and consents were obtained for all participants following 14 days of stroke recovery. The registry has been described in previous studies [13][14][15]. Our data analysis complies with the STROBE guidelines for cohort studies [16].…”

Section: Methodsmentioning

confidence: 91%

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

Scalise

Gainey

Bailes

et al. 2018

Preprint

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Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

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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]. 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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Pharmacological thrombolysis for acute ischemic stroke treatment: Gender differences in clinical risk factors

Cited by 26 publications

References 43 publications

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

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

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