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

Poupore, Nicolas; Strat, Dan; Mackey, Tristan; Brown, Katherine; Snell, Ashley; Nathaniel, Thomas I.

doi:10.1111/ncn3.12426

Cited by 14 publications

(14 citation statements)

References 30 publications

(71 reference statements)

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“…Serum HDL-c has antiatherogenic properties that allow flow of cholesterol to liver from peripheral cells, providing a defensive outcome [22]. Poupore et al discovered elevated LDL and higher lipoprotein levels in ischemic stroke patients compared to dyslipidemia trends in ischemic stroke patients [23]. They found that hypertension (74.3 %), hyperglycemia (64 %), and dyslipidemia (57.1 %), were the common risk factors and their findings on dyslipidemia were similar to ours.…”

Section: Discussionsupporting

confidence: 73%

Frequency of Dyslipidemia in Ischemic Stroke Patients Presented to Tertiary Care Hospital of Lahore

Jaffar¹,

Rafique²,

Khalid³

et al. 2021

PJMHS

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Background and Aim: A stroke, also known as a cerebrovascular accident, is defined as the sudden onset of a focal neurologic deficit caused by a disruption in blood flow to parts of the brain. The purpose of this study was to evaluate the frequency of dyslipidemia in stroke patients. Materials and Methods: This cross-sectional study was carried out on 184 stroke patients in Medical department of Services Hospital, Lahore for duration of six months i.e from November 2020 to June 2021. All the stroke patients admitted during the study period were enrolled. Demographic details, past medical and family history, stroke risk factors, blood pressure, body mass index, and diabetic state were noted. Fasting blood samples were taken from individuals of stroke diagnosed based on CT scan. Lipid profiles including triacylglycerol, cholesterol, fasting blood glucose, low-density lipoproteins, and glycosylated hemoglobin were all measured from an individual blood samples. SPSS version 20 was used for data analysis. Results: Of the total 184 stroke patients, 123 (66.8%) were male patients while 61 (33.2%) were females. The overall mean age was 41.35±12.76 years whereas the mean body mass index was 37.61±10.91 Kg/m2. Out of 184 patients, the prevalence of prevalent risk factors such as hypertension, diabetes mellitus, and smoking was found 146 (79.5%), 89 (48.2%), and 58 (31.7%) respectively. The prevalence of Hypercholesterolemia (mg/dl), Hypertriglyceridemia (mg/dl), High LDL (mg/dl) levels, high VLDL (mg/dl), and low HDL was 49 (26.4%), 37 (20.1%), 31 (16.8%), 23 (12.5%), and 13 (7.1%) respectively. The abnormalities in HbA1c and fasting blood glucose were found in 93 (50.6%) and 95 (51.4%). Conclusion: Dyslipidemia was more prevalent in ischemic stroke patients. The smoker and male population are more susceptible to stroke risks that involve high LDL, high HbA1c, low HDL, hypertension, and higher fast blood glucose. Family history and diabetes are other risk factors for stroke. Appropriate intrusion for alteration of uneven lipid profile can improve stroke prognosis and prevention Keywords: Dyslipidemia; Ischemic Stroke, Cholesterol

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Section: Discussionsupporting

confidence: 73%

Frequency of Dyslipidemia in Ischemic Stroke Patients Presented to Tertiary Care Hospital of Lahore

Jaffar¹,

Rafique²,

Khalid³

et al. 2021

PJMHS

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“…[ 69 ] Possible adverse events that have been associated with statin therapy are myopathy and hemorrhagic stroke. [ 23 ] Therefore, a more accurate understanding of the effectiveness and safety of different statins can be helpful in reducing a gender-specific higher total cholesterol. Therefore, understanding the different factors that impact men and women stroke populations is vital to promoting gender specific changes and this study is a step that provides information that can result in improved and better outcomes for patients.…”

Section: Discussionmentioning

confidence: 99%

“…This is because early admission is known to reduce poor outcome compared with 48 hours. [ 22 , 23 ] Data on patients with a suspicion of subarachnoid hemorrhage through CT findings (ICH, SAH, or other major infarct signs) was considered as a contraindication, and patients in this category were excluded. Demographics, clinical characteristics, laboratory values, and other pertinent data were obtained from a stroke registry; this registry has been described in previous studies.…”

Section: Methodsmentioning

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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“…[ 9 10 ] Other models including modified Rankin score and Barthel's index try to quantify functional outcomes of stroke recovery,[ 11 48 49 ] but none of these tests specifically measure motor recovery. [ 18 50 ] Our finding that changes in ambulatory outcome were associated with higher NIHSS scores and worsening neurologic outcome reveals that ambulatory function may serve as a significant quantitative measure and predictor of future outcomes following an anterior stroke in AIS patients with OSA. [ 27 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 46 47 48 ] This is because direct admission has been shown to reduce the door-to-needle time to <60 min in >70% of AIS patients and to <50 min in >45% of AIS patients. [ 49 50 51 ] Such a time improvement could be helpful when implementing the protocol of mixing and administering rtPA thrombolytic therapy to stroke patients, resulting in timely intervention that could lead to improved neurologic outcome.…”

Section: Discussionmentioning

confidence: 99%

Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

et al. 2021

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BACKGROUND: Specific clinical and demographic risk factors may be associated with improving or worsening neurologic outcomes within a population of acute ischemic stroke (AIS) patients with a history of obstructive sleep apnea (OSA). The objective of this study was to determine the changes in neurologic outcome during a 14-day recovery as it relates to initial stroke severity in AIS patients with OSA. METHODS: This retrospective study analyzed baseline clinical risk factors and demographic data collected in a regional stroke center from January 2010 to June 2016. Our primary endpoint measure was the National Institutes of Health Stroke Scale (NIHSS) score and our secondary endpoint measures included the clinical factors associated with improving (NIHSS score ≤7) or worsening (NIHSS score >7) neurological outcome. The relative contribution of each variable to stroke severity and related outcome was determined using a logistic regression. The regression models were checked for the overall correct classification percentage using a Hosmer–Lemeshow test, and the sensitivity of our models was determined by the area under the receiver operating characteristic curve. RESULTS: A total of 5469 AIS patients were identified. Of this, 96.89% did not present with OSA while 3.11% of AIS patients presented with OSA. Adjusted multivariate analysis demonstrated that in the AIS population with OSA, atrial fibrillation (AF) (odds ratio [OR] = 3.36, 95% confidence interval [CI], 1.289–8.762, P = 0.013) and changes in ambulatory status (OR = 2.813, 95% CI, 1.123–7.041, P = 0.027) showed an association with NIHSS score >7 while being Caucasian (OR = 0.214, 95% CI, 0.06–0.767, P = 0.018) was associated with NIHSS score ≤7. CONCLUSION: In AIS patients with OSA, AF and changes in ambulatory status were associated with worsening neurological outcome while Caucasian patients were associated with improving neurological outcome. Our findings may have significant implications for patient stratification when determining treatment protocols with respect to neurologic outcomes in AIS patients with OSA.

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

Cited by 14 publications

References 30 publications

Frequency of Dyslipidemia in Ischemic Stroke Patients Presented to Tertiary Care Hospital of Lahore

Frequency of Dyslipidemia in Ischemic Stroke Patients Presented to Tertiary Care Hospital of Lahore

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

Obstructive sleep apnea and stroke severity: Impact of clinical risk factors

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