Safety and early outcomes after intravenous thrombolysis in acute ischemic stroke patients with prestroke disability

Author:

Cooray Charith12ORCID,Karlinski Michal3ORCID,Kobayashi Adam4,Ringleb Peter5,Kõrv Janika6,Macleod Mary J7,Dixit Anand8,Azevedo Elsa910,Bladin Christopher11,Ahmed Niaz1

Affiliation:

1. Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden

2. Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden

3. Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland

4. Department of Neurology, Interventional Stroke Treatment Center, Center for Treatment of Multiple Sclerosis, Faculty of Medical and Health Sciences, Kazimierz Pulaski University of Technology and Humanities, Radom, Poland

5. Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany

6. Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia

7. Division of Applied Medicine, University of Aberdeen, Aberdeen, UK

8. University of Newcastle upon Tyne and Newcastle upon Tyne Hospitals NHS Foundation Trust, UK

9. Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal

10. 0Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal

11. 1Public Health Group, Stroke Division, Florey Institute of Neuroscience and Mental Health, the University of Melbourne, Australia

Abstract

Background There are limited data on intravenous thrombolysis treatment in ischemic stroke patients with prestroke disability. Aim We aimed to evaluate safety and outcomes of intravenous thrombolysis treatment in stroke patients with prestroke disability. Methods We analyzed 88,094 patients treated with intravenous thrombolysis, recorded in the Safe Implementation of Treatments in Stroke (SITS) International Thrombolysis Register between January 2003 and December 2017, with available NIHSS data at stroke-onset and after 24 h. Of them, 4566 patients (5.2%) had prestroke disability, defined as a modified Rankin Scale score of 3–5. Safety outcome measures included Symptomatic Intracerebral Hemorrhage, any type of parenchymal hematoma on 24 h imaging scans irrespective of clinical symptoms, and death within seven days. Early outcome measures were 24-h NIHSS improvement (≥4 from baseline to 24 h). Results Patients with prestroke disability were older, had more severe strokes, and more comorbidities than patients without prestroke disability. When comparing patients with prestroke disability with patients without prestroke disability, there was however no significant increase in adjusted odds for symptomatic intracerebral hemorrhage (adjusted odds ratio 0.83 (95% CI 0.60–1.15) (absolute difference in proportion 1.17% vs. 1.27%)) or for parenchymal hemorrhage (adjusted odds ratio 0.96 (0.83–1.11) (7.51% vs. 6.34%)). The prestroke disability group had a significantly lower-adjusted odds ratio for a 24-h NIHSS improvement (adjusted odds ratio 0.79 (0.73–0.85) (45.95% vs. 48.45%)) and a higher adjusted odds ratio for seven-day mortality (aOR 1.40 (1.21–1.61) (10.40% vs. 4.93%)). Conclusions Intravenous thrombolysis in acute ischemic stroke patients with prestroke disability was not associated with an increased risk of symptomatic intracerebral hemorrhage or parenchymal hemorrhage. Prestroke disability was however associated with a higher risk of early mortality compared to patients without prestroke disability.

Publisher

SAGE Publications

Subject

Neurology

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