Predicting Functional Outcome and Symptomatic Intracranial Hemorrhage in Patients With Acute Ischemic Stroke

Ntaios, George; Papavasileiou, Vasileios; Michel, Patrik; Tatlısumak, Turgut; Strbian, Daniel

doi:10.1161/strokeaha.114.003665

Cited by 33 publications

(29 citation statements)

References 107 publications

(114 reference statements)

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“…In studies comparing scores for sICH, the c-statistic ranged mostly between 0.60 and 0.80, suggesting the accuracy was modest to good ( 20 , 21 ). Therefore, identifying additional risk factors of sICH may improve the accuracy of predictive scores, making them more precise ( 22 , 23 ). Our study shows that preexisting treatment with medium and high-dose statins is possibly an important additional risk factor and should be considered in future studies investigating rt-PA-related hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…Risk factors for sICH after thrombolysis such as stroke severity, onset-to-treatment time, and early signs of infarction on CT may reflect the extent and progression of ischemic injury to the blood–brain barrier. Other risk factors such as stroke-associated hyperglycemia and hypertension may represent an acute stroke-related stress reaction ( 24 , 25 ), and there is debate whether stroke-associated hyperglycemia is merely an epiphenomenon (and a marker) or a cause of poor outcome and sICH ( 22 , 26 ). In contrast to these risk factors, the novel candidate risk factor pretreatment with statins may contribute to a higher risk of clinically relevant hemorrhage after rt-PA via different mechanisms.…”

Section: Discussionmentioning

confidence: 99%

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A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

et al. 2018

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BackgroundSymptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) for acute ischemic stroke is associated with a poor functional outcome. We aimed to develop a score assessing risk of sICH including novel putative predictors—namely, pretreatment with statins and severe renal impairment.MethodsWe analyzed our local cohort (Berlin) of patients receiving rt-PA for acute ischemic stroke between 2006 and 2016. Outcome was sICH according to ECASS-III criteria. A multiple regression model identified variables associated with sICH and receiver operating characteristics were calculated for the best discriminatory model for sICH. The model was validated in an independent thrombolysis cohort (Basel).ResultssICH occurred in 53 (4.0%) of 1,336 patients in the derivation cohort. Age, baseline National Institutes of Health Stroke Scale, systolic blood pressure on admission, blood glucose on admission, and prior medication with medium- or high-dose statins were associated with sICH and included into the risk of intracranial hemorrhage score. The validation cohort included 983 patients of whom 33 (3.4%) had a sICH. c-Statistics for sICH was 0.72 (95% CI 0.66–0.79) in the derivation cohort and 0.69 (95% CI 0.60–0.77) in the independent validation cohort. Inclusion of severe renal impairment did not improve the score.ConclusionWe developed a simple score with fair discriminating capability to predict rt-PA-related sICH by adding prior statin use to known prognostic factors of sICH. This score may help clinicians to identify patients with higher risk of sICH requiring intensive monitoring.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

et al. 2018

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“…Several prognostic scores were recently introduced for outcome prediction in acute ischaemic stroke patients, which could be helpful in the clinical and research setting . Amongst others, the ASTRAL score predicts functional outcome in the general ischaemic stroke population , and the DRAGON and SEDAN scores predict functional outcome and symptomatic intracranial haemorrhage (sICH) respectively in patients treated with intravenous thrombolysis (IVT) .…”

Section: Introductionmentioning

confidence: 99%

ASTRAL, DRAGON and SEDAN scores predict stroke outcome more accurately than physicians

Ntaios

Gioulekas

Papavasileiou

et al. 2016

Euro J of Neurology

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“…However, among patients that have undergone successful reperfusion, the neurological outcome is occasionally variable and unpredictable (Ntaios et al . ; Seners et al . ).…”

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confidence: 99%

“…Achieving a timely vascular reperfusion is a fundamental factor in order to reduce tissue injury and improve function (Prabhakaran et al 2015). However, among patients that have undergone successful reperfusion, the neurological outcome is occasionally variable and unpredictable (Ntaios et al 2015;Seners et al 2015). Whether changes occurring in the brain parenchyma upon a period of ischemia may affect the neurological outcome after reperfusion is currently a matter of debate (Benakis et al 2015;Schoknecht et al 2015).…”

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confidence: 99%

Increased thrombin activity following reperfusion after ischemic stroke alters synaptic transmission in the hippocampus

Bushi

Shimon

Stein

et al. 2015

Journal of Neurochemistry

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Thrombin, a key player in thrombogenesis, affects cells in the brain through activation of its receptors. Low levels of thrombin activity are protective while high levels are toxic. We sought to quantify thrombin activity levels and their spatial distribution in brains of mice following reperfusion after ischemic stroke focusing on infarct, peri-infarct and contralateral areas. In order to find out the contribution of brain-derived thrombin, mRNA levels of both prothrombin and factor X were determined. Furthermore, we assessed the effect of thrombin levels that were measured in the ischemic brain on synaptic transmission. We found that in the brains of mice following transient middle cerebral artery occlusion, thrombin activity is elevated throughout the ischemic hemisphere, including in peri-infarct areas (90 AE 33 and 60 AE 18 mU/mL, in the infarct and peri-infarct areas, respectively, compared to 11 AE 3 and 12 AE 5 mU/mL, in the corresponding contralateral areas; mean AE SE; p < 0.05). Brain mRNA levels of prothrombin and, in particular, factor X are up-regulated in the ischemic core. Hippocampal slices treated with thrombin concentrations as found in the ischemic hemisphere show altered synaptic responses. We conclude that high thrombin activity following reperfusion after ischemic stroke may cause synaptic dysfunction.

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Predicting Functional Outcome and Symptomatic Intracranial Hemorrhage in Patients With Acute Ischemic Stroke

Abstract: Downloaded from 900 StrokeMarch 2015

Cited by 33 publications

References 107 publications

A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

A Score for Risk of Thrombolysis-Associated Hemorrhage Including Pretreatment with Statins

ASTRAL, DRAGON and SEDAN scores predict stroke outcome more accurately than physicians

Increased thrombin activity following reperfusion after ischemic stroke alters synaptic transmission in the hippocampus

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