3-Month Outcome of Ischemic Stroke Patients Underwent Thrombolytic Therapy; a Cohort Study
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
7 January 2020
Introduction: Reperfusion and neuroprotection are 2 main treatment strategies exist for management of patients with ischemic stroke. This study aimed to assess the 3-month outcome of patients who underwent thrombolytic therapy following ischemic stroke.
Methods: In the present prospective cohort study, the 3-month outcome of patients (mortality, disability) with acute ischemic stroke admitted to neurology department an educational hospital, Kermanshah, Iran, from 2016 to 2019, who had received thrombolytic therapy was assessed. National Institute of Health Stroke Scale (NIHSS) and Modified Rankin Score (MRS) were used for measuring the degree of disability (on admission, at the time of discharge and 3 months after thrombolytic therapy).
Results: 217 patients with the mean age of 66.40 Â± 13.37 (27 â€“ 97) years were studied (55.3% male). There was no significant correlation between decrease in NIHSS score and age (p = 0.44), sex (p = 0.082), time interval between initiation of symptoms (p = 0.104), and blood pressure on admission (p = 0.156). However, patients with blood sugar lower than 144 had better 3-month outcome (p = 0.045). Additionally, there was no significant correlation between the rate of decrease in MRS score and age (p = 0.813), sex (p = 0.875), time interval between initiation of symptoms (p = 0.495), and blood pressure on admission (p = 0.264). However, patients with blood sugar lower than 144 had better 3-month outcome (p = 0.022). 47 (21.7%) patient died and 170 (78.3%) were discharged. Mean age of the patients who died (73.70 Â± 11.85 versus 64.39 Â± 13.09 years; p < 0.0001) and their NIHSS score on admission (13.22 Â± 6.01 versus 11.28 Â± 5.70; p = 0.045) were significantly higher. In other words, the odds of mortality was 3.19 times in patients over 60 years of age (95% confidence interval (CI): 1.18 â€“ 8.62) and 1.83 times in patients with NIHSS score over 12 (95% CI: 0.92 â€“ 3.61).
Conclusion: There was no significant correlation between 3-month disabilities of stroke patients underwent thrombolytic therapy and age, sex, time from initiation of symptoms, or vital signs on admission. Patients with a blood sugar lower than 144 had better 3-month outcome.
- Tissue plasminogen activator
- brain ischemia
- stroke rehabilitation
How to Cite
Singh R, Suh I, Singh V, Chaithiraphan S, Laothavorn P, Sy R, et al. Hypertension and stroke in Asia: prevalence, control and strategies in developing countries for prevention. Journal of human hypertension. 2000;14(10):749.
Brott T, Haley EC, Levy DE, Barsan WG, Reed RL, Olinger CP, et al. The investigational use of tPA for stroke. Annals of emergency medicine. 1988;17(11):1202-5.
Deguchi K, Miyazaki K, Tian F, Liu N, Liu W, Kawai H, et al. Modifying neurorepair and neuroregenerative factors with tPA and edaravone after transient middle cerebral artery occlusion in rat brain. Brain research. 2012;1436:168-77.
Kim JS. Stroke in Asia: a global disaster. International Journal of Stroke. 2014;9(7):856-7.
Zhang W, Sato K, Hayashi T, Omori N, Nagano I, Kato S, et al. Extension of ischemic therapeutic time window by a free radical scavenger, Edaravone, reperfused with tPA in rat brain. Neurological research. 2004;26(3):342-8.
Jones TH, Morawetz RB, Crowell RM, Marcoux FW, FitzGibbon SJ, DeGirolami U, et al. Thresholds of focal cerebral ischemia in awake monkeys. Journal of neurosurgery. 1981;54(6):773-82.
Rosamond WD, Folsom AR, Chambless LE, Wang C-H, McGovern PG, Howard G, et al. Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke. 1999;30(4):736-43.
Bambauer KZ, Johnston SC, Bambauer DE, Zivin JA. Reasons why few patients with acute stroke receive tissue plasminogen activator. Archives of neurology. 2006;63(5):661-4.
Boudreau DM, Guzauskas GF, Chen E, Lalla D, Tayama D, Fagan SC, et al. Cost-effectiveness of recombinant tissue-type plasminogen activator within 3 hours of acute ischemic stroke: current evidence. Stroke. 2014;45(10):3032-9.
Barber P, Zhang J, Demchuk A, Hill M, Buchan A. Why are stroke patients excluded from TPA therapy?: An analysis of patient eligibility. Neurology. 2001;56(8):1015-20.
Graham GD. Tissue plasminogen activator for acute ischemic stroke in clinical practice: a meta-analysis of safety data. Stroke. 2003;34(12):2847-50.
Katzan IL, Furlan AJ, Lloyd LE, Frank JI, Harper DL, Hinchey JA, et al. Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. Jama. 2000;283(9):1151-8.
Kasner SE, Chalela JA, Luciano JM, Cucchiara BL, Raps EC, McGarvey ML, et al. Reliability and validity of estimating the NIH stroke scale score from medical records. Stroke. 1999;30(8):1534-7.
Cohen J. Interrater reliability and predictive validity of the FOUR score coma scale in a pediatric population. Journal of Neuroscience Nursing. 2009;41(5):261-7.
Eken C, Kartal M, Bacanli A, Eray O. Comparison of the Full Outline of Unresponsiveness Score Coma Scale and the Glasgow Coma Scale in an emergency setting population. European journal of emergency medicine. 2009;16(1):29-36.
Lyden PD. Thrombolytic therapy for stroke: Springer Science & Business Media; 2001.
Baratloo A, Forouzanfar MM, Hashemi B, Safari S, Kasmaei HD, Rouhipour A, et al. Tissue plasminogen activator: A literature review. Archives of Neuroscience. 2016;3(1).
Dong Y, Cao W, Ren J, Nair DS, Parker S, Jahnel JL, et al. Vascular risk factors in patients with different subtypes of ischemic stroke may affect their outcome after intravenous tPA. PloS one. 2015;10(8):e0131487.
Tosta ED, Rebello LC, Almeida SS, Neiva MSS. Treatment of ischemic stroke with r-tPA: implementation challenges in a tertiary hospital in Brazil. Arquivos de neuro-psiquiatria. 2014;72(5):368-72.
Mehta A, Mahale R, Buddaraju K, Majeed A, Sharma S, Javali M, et al. Intravenous thrombolysis for acute ischemic stroke: review of 97 patients. Journal of neurosciences in rural practice. 2017;8(1):38.
Albers GW, Bates VE, Clark WM, Bell R, Verro P, Hamilton SA. Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. Jama. 2000;283(9):1145-50.
- Abstract Viewed: 151 times
- PDF Downloaded: 109 times
- HTML Downloaded: 50 times