Intravenous Thrombolysis Attenuates Neurologic Deterioration After Ischemic Stroke

    loading  Checking for direct PDF access through Ovid

Abstract

Introduction

Although intravenous tissue plasminogen activator (IV tPA) is associated with neurologic deterioration (ND) caused by hemorrhage, whether it attenuates deterioration as a result of other etiologies including progressive stroke remains unexplored. The objective of this study was to determine whether IV tPA is associated with a reduced risk of ND caused by progressive stroke.

Methods

A retrospective investigation of consecutively admitted patients with acute ischemic stroke (July 2008–June 2014) within 4.5 hours of symptom onset was conducted at a tertiary care center. Patients treated with IV tPA were compared with those who were not. The primary outcome was ND resulting from progressive infarction (a two-point increase in the National Institutes of Health Stroke Scale score during a 24-hour period).

Results

A total of 699 registry patients (median age 65 years, interquartile range 55–76, 48.4% women, 70.4% nonwhite) were included in the study, and 58.1% received IV tPA. In crude regression, IV tPA did not reduce the odds of ND caused by progressive infarction; however, IV tPA–treated patients were at a 55% lower odds of ND from any cause (odds ratio 0.45, 95% confidence interval 0.32–0.61, P < 0.001). After adjusting for covariates, IV tPA use remained strongly associated with a 39% lower odds of ND from any cause (odds ratio 0.61, 95% confidence interval 0.48–0.79, P < 0.001).

Conclusions

Although IV tPA did not correlate with a reduced odds of progressive infarction, it was significantly associated with a lower odds of ND by any mechanism.

Related Topics

    loading  Loading Related Articles