Thrombolysis Therapy in Specialized and Non-specialized Stroke Units

Blum, Brice; Brechtel, Leanne; Nathaniel, Thomas I.

doi:10.1016/j.arcmed.2019.01.002

Cited by 17 publications

(10 citation statements)

References 38 publications

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“…The adjusted analysis did not eliminate the effect of age as the sustained effect of increasing age manifested in the rtPA group. 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].…”

Section: Discussionsupporting

confidence: 86%

Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

et al. 2020

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Aim: The aim of this study was to determine the predictive value of clinical presentations on functional ambulation following thrombolytic therapy. Materials & methods: Logistic regression analysis was used to determine associations between functional ambulation and thrombolytic therapy. Results & conclusion: In the results, Hispanic ethnicity (odds ratio (OR): 2.808; p = 0.034; 95% CI: 1.08–7.30), high National Institute of Health Stroke Scale (NIHSS) (OR: 1.112; p ≤ 0.001; 95% CI: 1.06–1.17), weakness/paresis (OR: 1.796; p = 0.005; 95% CI: 1.19–2.71), Broca’s aphasia (OR: 1.571; p = 0.003; 95% CI = 1.16–2.12) and antihypertensive medication (OR: 1.530; p = 0.034; 95% CI: 1.03–2.26) were associated with an improved ambulation in patients without thrombolytic therapy. In thrombolytic treated patients, Broca’s aphasia was associated with improved functional outcome.

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Section: Discussionsupporting

confidence: 86%

Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

et al. 2020

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“…Despite this well‐established connection between obesity and stroke risk, several clinical studies indicate that obese ischemic stroke patients have improved mortality and morbidity. For example, increased BMI is directly linked with improved outcomes in post‐stroke treatment with rtPA, including a reduced risk of recurrent stroke, 17,25,26 morbidity, 23 and improved functional recovery 7,27,28 . These findings support our current result of inclusion of obese TIA‐ischemic stroke patients for rtPA.…”

Section: Discussionsupporting

confidence: 77%

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

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Mackey

et al. 2020

Neurology & Clinical Neurosc

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Background This study investigates the risk factors associated with exclusion or inclusion for thrombolytic therapy in TIA‐ischemic stroke patients in a telestroke compared with a non‐telestroke setting. Methods This study retrospectively analyzes regional stroke data collected between January 2010 and June 2016 from TIA‐ischemic stroke patients. We used the logistic regression model to predict clinical risk factors associated with exclusion or inclusion for thrombolytic therapy in the telestroke and non‐telestroke setting. Results This study identified a total of 299 ischemic stroke patients with a history of TIAs. Of these, 98 patients received treatment in a telestroke setting, while 201 received treatment in a non‐telestroke setting. The telestroke excluded fewer patients (58%) and administered thrombolytic therapy to 42% of TIA‐ischemic stroke patients. The non‐telestroke setting excluded 89% of patients, while only 11% of TIA‐ischemic stroke patients received rtPA. In the telestroke setting, a history of previous TIA > 24 hours (OR = 16.014, 95% CI, 4.112‐62.368, P < .001) was associated with rtPA inclusion, while higher blood glucose levels (OR = 0.984, 95% CI, 0.969‐0.999, P = .042) were associated with an rtPA exclusion. Conclusion After adjusting for the effect of confounding variables, we found direct admission to be significant for exclusion in the non‐telestroke setting. Moreover, there was a significant association between hyperglycemia and exclusion from thrombolytic therapy in TIA‐ischemic stroke patients in the telestroke setting.

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“…It has been shown that specific comorbidities may influence the benefits of thrombolytic therapy in patients with ischemic stroke. [19][20][21][22][23][24][25] In addition, we know that some risk factors for TIA and ischemic stroke including hypertension (HTN), diabetes, and heart diseases 20,[25][26][27][28][29][30][31] may interact with thrombolytic therapy to significantly modulate ambulation and affect treatment outcome. In this case, one possibility is that perhaps specific clinical risk factors in patients with TIA-ischemic stroke may increase the odds of good or poor functional ambulation outcome because of the resulting interactive effect with thrombolytic therapy.…”

Section: Introductionmentioning

confidence: 99%

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

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Strat

Mackey

et al. 2020

Clin Appl Thromb Hemost

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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.

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Thrombolysis Therapy in Specialized and Non-specialized Stroke Units

Cited by 17 publications

References 38 publications

Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

Predicting Ambulatory Recovery in Acute Ischemic Stroke Patients with Thrombolytic Therapy

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

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

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