Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

Scalise, Matthew; Brechtel, Leanne; Conn, Zachary; Bailes, Benjamin; Gainey, Jordan; Nathaniel, Thomas I.

doi:10.2217/fnl-2020-0002

Cited by 8 publications

(6 citation statements)

References 51 publications

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“…We observed that in AIS patients with atrial fibrillation, migraines, elevated HDL-cholesterol and LDL-cholesterol with the inability to ambulate on admission were associated with females, while history of drug and alcohol abuse, sleep apnea, and higher serum creatinine level were associated with male AIS patients with AF. Our finding of the association of poor ambulatory outcome with female AIS with AF is consistent with existing evidence on stroke patients [ 37 ]. This finding indicates that stroke is not only a leading cause of death, but it is also a leading cause of disability including poor ambulatory outcome particularly in females in whom poor functional outcomes due to a stroke consistently exceeds male patients [ 38 ].…”

Section: Discussionsupporting

confidence: 92%

Gender differences in comorbidities and risk factors in ischemic stroke patients with a history of atrial fibrillation

et al. 2021

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Background Atrial Fibrillation (AF) is a common cardiac arrhythmia and has been identified as a major risk factor for acute ischemic stroke (AIS). Gender differences in the disease process, causative mechanisms and outcomes of AF have been investigated. In the current study, we determined whether there is a gender-based disparity in AIS patients with baseline AF, and whether such a discrepancy is associated with specific risk factors and comorbidities. Methods Baseline factors including comorbidities, risk and demographic factors associated with a gender difference were examined using retrospective data collected from a registry from January 2010 to June 2016 in a regional stroke center. Univariate analysis was used to differentiate between genders in terms of clinical risk factors and demographics. Variables in the univariate analysis were further analyzed using logistic regression. The adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each factor were used to predict the increasing odds of an association of a specific comorbidity and risk factor with the male or female AIS with AF. Results In the population of AIS patients with AF, a history of drug and alcohol use (OR = 0.250, 95% CI, 0.497–1.006, P = 0.016), sleep apnea (OR = 0.321, 95% CI, 0.133–0.777, P = 0.012), and higher serum creatinine (OR = 0.693, 95% CI, 0.542–0.886 P = 0.003) levels were found to be significantly associated with the male gender. Higher levels of HDL-cholesterol (OR = 1.035, 95% CI, 1.020–1.050, P < 0.001), LDL-cholesterol (OR = 1.006, 95% CI, 1.001–1.011, P = 0.012), and the inability to ambulate on admission to hospital (OR = 2.258, 95% CI, 1.368–3.727, P = 0.001) were associated with females. Conclusion Our findings reveal that in the AIS patients with atrial fibrillation, migraines, HDL, LDL and poor ambulation were associated with females, while drugs and alcohol, sleep apnea, and serum creatinine level were associated with male AIS patients with AF. Further studies are necessary to determine whether gender differences in risk factor profiles and commodities require consideration in clinical practice when it comes to AF as a risk factor management in AIS patients.

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Section: Discussionsupporting

confidence: 92%

Gender differences in comorbidities and risk factors in ischemic stroke patients with a history of atrial fibrillation

et al. 2021

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“…While coronary artery disease is well known to be associated with increased risk for stoke, [ 45 – 47 ] the association of a history of drug or alcohol abuse, increased diastolic blood pressure and related gender differences in AIS is not as clear. There is a documented link of cocaine use and stroke, with cocaine users demonstrating quicker clot formation with a decreased overall clot strength and therefore an increased association with ICH, [ 48 ] but other drugs and alcohol are not as well elucidated. Alcoholic withdrawal has been associated with poorer outcome in AIS patients, [ 49 ] but differences in gender and the impact of heavy alcohol use pre and post-stroke is not well studied.…”

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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“…It has also been shown that age may influence the outcome and risk of hemorrhage after rtPA therapy [58][59][60]. Therefore, increasing age is associated with an increased number of comorbidities and worse outcomes regardless of rtPA-related complications [61][62][63]. While studies have not shown age alone to negate the beneficial effects of rtPA, the benefits of statins treatment in the elderly is controversial because neurological outcome is associated with many clinical and demographic factors.…”

Section: Discussionmentioning

confidence: 99%

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

Poupore

Strat

Mackey

et al. 2020

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Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy. Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions. Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions. Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.

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Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

Cited by 8 publications

References 51 publications

Gender differences in comorbidities and risk factors in ischemic stroke patients with a history of atrial fibrillation

Gender differences in comorbidities and risk factors in ischemic stroke patients with a history of atrial fibrillation

Comorbidities associated with different levels of total cholesterol in male and female acute ischemic stroke patients

Cholesterol reducer and thrombolytic therapy in acute ischemic stroke patients

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