The Association Between an Antecedent of Transient Ischemic Attack Prior to Onset of Stroke and Functional Ambulatory Outcome

Abstract

Background: Specific clinical risk factors linked to transient ischemic attack (TIA) could affect functional ambulatory outcome following thrombolytic therapy in patients having ischemic stroke with a prior TIA (TIA-ischemic stroke). This issue was investigated in this study. Methods: We retrospectively analyzed data from 6379 ischemic stroke patients of which 1387 presented with an antecedent TIA prior to onset of stroke. We used logistic regression model to identify demographic and clinical risk factors that are associated with functional ambulatory outcome in patients with TIA-ischemic stroke treated with thrombolytic therapy. Results: In a population of TIA-ischemic stroke who received recombinant tissue plasminogen activator, patients with a history of stroke (odds ratio [OR] = 3.229, 95% confidence interval [CI] = 1.494-6.98, P = .003) were associated with increasing odds of improvement in functional ambulation, while the female gender (OR = 0.462, 95% CI = 0.223-0.956, P = .037) was associated with reducing odds of improvement. In the non-TIA group, dyslipidemia (OR = 1.351, 95% CI = 1.026-1.781, P = .032) and blood glucose (OR = 1.003, 95% CI = 1.0-1.005, P = .041) were associated with the increasing odds of improvement while older patients (OR = 0.989, 95% CI = 0.98-0.999, P = .029) with heart failure (OR = 0.513, 95% CI = 0.326-0.808, P = .004) and higher lipid level (OR = 0.834, 95% CI = 0.728-0.955, P = .009) were associated with reducing odds of improvement in ambulation. Conclusion: In a population of TIA-ischemic stroke with thrombolytic therapy and a clearly defined TIA without focal ischemic injury, regardless of associated clinical risk factors, a TIA prior to a stroke is not associated with reducing odds of improved ambulatory outcome, except in female patients with TIA-ischemic stroke.

Thrombolytic therapy in ischemic stroke patients with a preceding transient ischemic attack in telestroke and non‐telestroke settings

“…These findings support our current result indicating that inclusion of TIA‐ischemic population with antidepressant therapy in non‐depressed stroke patients for rtPA therapy may reduce the odds for development of PSD and improve functional recovery. In general, our findings are supported by other studies analyzing the possible effect of prior TIA on outcomes post‐thrombolysis, where significant favorable outcomes were observed 20,30 . Factors such as obesity, lower NIH scores, younger age, and lower blood glucose levels upon admission were reported with better post‐thrombolysis outcomes among stroke patients 31‐33 …”

“…A significant number of patients diagnosed with TIA develop a stroke within 48 hours, 18 indicating that TIA is a medical emergency. Since TIA is a medical emergency, a quick assessment of patients with a TIA and appropriate medical intervention are mandatory, and the evaluating neurologist is usually expected to evaluate the probability of future stroke after a TIA 19,20 …”

Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

“…Our model predicted lower chances of recovery from a stroke within octogenarian and nonagenarian patients, due to their higher risk of subsequent complications [37,38]. This finding is consistent with observational studies in which octogenarians and nonagenarians have lower chances of achieving favorable outcomes than patients <80 years old [16,[39][40][41]. The nonimproved or poor ambulatory outcomes of elderly patients may be in part due to their numerous comorbidities [42][43][44], as well as their decreased likelihood of regaining motoric functions following thrombolytic therapy [45][46][47].…”

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

“…Several studies have shown that women are more likely to present with stroke at an older age. [ 3 , 32 , 33 ] It has also been shown that women are more likely to have a severe stroke when compared to men. [ 3 , 34 ] In addition, the prevalence of hypertension, atrial fibrillation, dyslipidemia, and obesity are greater in women.…”