Multidimensional Outcomes of IV Thrombolysis in Minor Ischemic Stroke: Motor, Psychocognitive, and Dependence.
alteplase
ischemic
minor stroke
outcomes
Journal
Neuropsychiatric disease and treatment
ISSN: 1176-6328
Titre abrégé: Neuropsychiatr Dis Treat
Pays: New Zealand
ID NLM: 101240304
Informations de publication
Date de publication:
2023
2023
Historique:
received:
10
08
2023
accepted:
24
10
2023
medline:
8
11
2023
pubmed:
8
11
2023
entrez:
8
11
2023
Statut:
epublish
Résumé
The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase. This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes. A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22-8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17-4.50). There was an association of alteplase with better gait speed in the restricted sample of age >60 (OR,0.14; 95% CI, 0.02-0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91-3.55) and depression (OR, 1.54; 95% CI, 0.17-2.91) in female. Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0-5. Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future.
Sections du résumé
Background
UNASSIGNED
The presence of mild deficit is the most common reason for nonuse of intravenous alteplase in ischemic stroke. We analyzed within a national prospective cohort on whether patients with minor stroke can benefit from intravenous alteplase.
Methods
UNASSIGNED
This observational study included patients with acute ischemic stroke with a National Institutes of Health Stroke Scale (NIHSS) score 0 to 5 at admission. The short-term outcomes at discharge and 3-month were analyzed including the modified Rankin Scale score, gait speed, Montreal Cognitive Assessment, Patient Health Questionnaire-9, General Anxiety Disorder-7 and Stroke Impact Scale-16. Multivariate regression models were performed to evaluate the association between intravenous thrombolysis and clinical outcomes.
Results
UNASSIGNED
A total of 1876 consecutive patients were included in the current analyses with 102 patients (5.4%) received alteplase and 1774 patients (94.5%) were in non-alteplase group. We found that 10.9% patients presented unfavorable functional outcome with a mRS ≥ 2 at 3-month. Patients with alteplase treatment had a more favorable outcome in SIS-16 at discharge (OR, 5.45; 95% CI, 2.22-8.68) and 3-month after stroke (OR, 2.34; 95% CI, 0.17-4.50). There was an association of alteplase with better gait speed in the restricted sample of age >60 (OR,0.14; 95% CI, 0.02-0.25), while an unfavorable effect was found in anxiety (OR, 2.23; 95% CI, 2.23, 0.91-3.55) and depression (OR, 1.54; 95% CI, 0.17-2.91) in female.
Conclusion
UNASSIGNED
Alteplase showed a suggestive benefit in function and motor outcomes in patients with low NIHSS score of 0-5. Meanwhile, female seemed more inclined to post-stroke emotional problems after alteplase treatment, which should be further explored in the future.
Identifiants
pubmed: 37936866
doi: 10.2147/NDT.S434296
pii: 434296
pmc: PMC10625889
doi:
Types de publication
Journal Article
Langues
eng
Pagination
2341-2351Informations de copyright
© 2023 Li et al.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest in this work.
Références
Front Neurol. 2021 Aug 11;12:676872
pubmed: 34456843
J Clin Med. 2020 Mar 12;9(3):
pubmed: 32178336
BMC Psychiatry. 2022 Sep 9;22(1):601
pubmed: 36085028
Phys Ther. 2009 Aug;89(8):816-25
pubmed: 19520733
Neurology. 2018 Nov 13;91(20):e1838-e1850
pubmed: 30333158
Stroke. 2009 Aug;40(8):2805-11
pubmed: 19556535
Lancet Neurol. 2006 Jul;5(7):603-12
pubmed: 16781990
Stroke Vasc Neurol. 2022 Apr 26;:
pubmed: 35474180
J Rehabil Res Dev. 2003 Jan-Feb;40(1):1-8
pubmed: 15150715
JAMA. 2018 Jul 10;320(2):141-143
pubmed: 29998321
J Gen Intern Med. 2001 Sep;16(9):606-13
pubmed: 11556941
Stroke. 2016 May;47(5):1278-85
pubmed: 26987870
Stroke. 2014 Aug;45(8):2354-8
pubmed: 25013020
Stroke. 2012 Nov;43(11):3018-22
pubmed: 22984013
Br J Psychiatry. 1994 Mar;164(3):380-6
pubmed: 8199792
J Gerontol A Biol Sci Med Sci. 2022 Aug 12;77(8):1620-1628
pubmed: 34984437
Stroke. 2014 Mar;45(3):765-9
pubmed: 24481972
Stroke. 2010 Apr;41(4):661-6
pubmed: 20185781
Stroke. 2005 Nov;36(11):2497-9
pubmed: 16210552
Neurology. 2016 Oct 11;87(15):1565-1574
pubmed: 27629092
BMC Geriatr. 2022 Dec 31;22(1):1009
pubmed: 36585624
Neurology. 2018 Oct 30;91(18):e1728-e1731
pubmed: 30373931
Stroke. 2015 May;46(5):e114-7
pubmed: 25813192
JAMA Neurol. 2015 Apr;72(4):423-31
pubmed: 25642650
J Stroke Cerebrovasc Dis. 2013 May;22(4):550-3
pubmed: 23433783
Int J Stroke. 2018 Aug;13(6):654-661
pubmed: 29570044
Stroke. 2021 Jun;52(6):1995-2004
pubmed: 33947209
Neurology. 2016 May 10;86(19):1801-7
pubmed: 27164715
Ann Transl Med. 2021 May;9(9):767
pubmed: 34268380
J Eval Clin Pract. 2008 Aug;14(4):552-62
pubmed: 18462283
J Adv Nurs. 2001 Apr;34(2):203-11
pubmed: 11430282
J Atheroscler Thromb. 2022 Sep 1;29(9):1372-1382
pubmed: 34744099
Stroke. 2018 Mar;49(3):638-645
pubmed: 29459397
Stroke Vasc Neurol. 2018 Jan 5;3(1):22-27
pubmed: 29600004
Stroke. 2012 Feb;43(2):560-2
pubmed: 22052513
Stroke Vasc Neurol. 2019 Jun 29;4(3):158-164
pubmed: 31709123
Stroke. 2016 Jul;47(7):1914-6
pubmed: 27197850
JAMA. 2011 Jan 5;305(1):50-8
pubmed: 21205966
Stroke. 2010 Nov;41(11):2581-6
pubmed: 20814000
Stroke. 1988 May;19(5):604-7
pubmed: 3363593
Stroke. 2019 Dec;50(12):e344-e418
pubmed: 31662037
Arch Phys Med Rehabil. 2006 Mar;87(3):358-63
pubmed: 16500169
Neurology. 2003 Jan 28;60(2):291-6
pubmed: 12552047
Lancet. 1999 May 22;353(9166):1728
pubmed: 10347982