Rescue therapy of early neurological deterioration in lacunar stroke.
Humans
Male
Female
Stroke, Lacunar
/ drug therapy
Aged
Middle Aged
Anticoagulants
/ therapeutic use
Hypertension
/ drug therapy
Aged, 80 and over
Sulfonamides
/ therapeutic use
Arginine
/ analogs & derivatives
Treatment Outcome
Antihypertensive Agents
/ therapeutic use
Retrospective Studies
Disease Progression
Pipecolic Acids
Anticoagulation
Branch atheroma
Early neurological deterioration
Lacunar stroke
Pharmacologically induced hypertension
Rescue therapy
Journal
BMC neurology
ISSN: 1471-2377
Titre abrégé: BMC Neurol
Pays: England
ID NLM: 100968555
Informations de publication
Date de publication:
07 Sep 2024
07 Sep 2024
Historique:
received:
07
06
2024
accepted:
26
08
2024
medline:
8
9
2024
pubmed:
8
9
2024
entrez:
7
9
2024
Statut:
epublish
Résumé
Early neurological deterioration (END) occurs in many patients with acute ischemic stroke due to a variety of causes. Although pharmacologically induced hypertension (PIH) and anticoagulants have been investigated in several clinical trials for the treatment of END, the efficacy and safety of these treatments remain unclear. Here, we investigated whether PIH or anticoagulation is better as a rescue therapy for the progression of END in patients with lacunar stroke. This study included patients with lacunar stroke who received rescue therapy with END within 3 days of symptom onset between April 2014 and August 2021. In the PIH group, phenylephrine was administered intravenously for 24 h and slowly tapered when symptoms improved or after 5 days of PIH. In the anticoagulation group, argatroban was administered continuously intravenously for 2 days and twice daily for next 5 days. We compared END recovery, defined as improvement in NIHSS from baseline, excellent outcomes (0 or 1 mRS at 3 months), and safety profile. Among the 4818 patients with the lacunar stroke, END occurred in 147 patients. Seventy-nine patients with END received PIH (46.9%) and 68 patients (46.3%) received anticoagulation therapy. There was no significant difference in age (P = 0.82) and sex (P = 0.87) between the two groups. Compared to the anticoagulation group, the PIH group had a higher incidence of END recovery (77.2% vs. 51.5%, P < 0.01) and excellent outcomes (34.2% vs. 16.2%, P = 0.04). PIH was associated with END (HR 2.49; 95% CI 1.06-5.81, P = 0.04). PIH remained associated with END recovery (adjusted HR 3.91; 95% CI 1.19-12.90, P = 0.02). Safety outcomes, like hemorrhagic conversion and mortality, were not significantly different between the two groups. As a rescue therapy for the progression of END in lacunar stroke patients, PIH with phenylephrine was more effective with similar safety compared to anticoagulation with argatroban.
Sections du résumé
BACKGROUND
BACKGROUND
Early neurological deterioration (END) occurs in many patients with acute ischemic stroke due to a variety of causes. Although pharmacologically induced hypertension (PIH) and anticoagulants have been investigated in several clinical trials for the treatment of END, the efficacy and safety of these treatments remain unclear. Here, we investigated whether PIH or anticoagulation is better as a rescue therapy for the progression of END in patients with lacunar stroke.
METHODS
METHODS
This study included patients with lacunar stroke who received rescue therapy with END within 3 days of symptom onset between April 2014 and August 2021. In the PIH group, phenylephrine was administered intravenously for 24 h and slowly tapered when symptoms improved or after 5 days of PIH. In the anticoagulation group, argatroban was administered continuously intravenously for 2 days and twice daily for next 5 days. We compared END recovery, defined as improvement in NIHSS from baseline, excellent outcomes (0 or 1 mRS at 3 months), and safety profile.
RESULTS
RESULTS
Among the 4818 patients with the lacunar stroke, END occurred in 147 patients. Seventy-nine patients with END received PIH (46.9%) and 68 patients (46.3%) received anticoagulation therapy. There was no significant difference in age (P = 0.82) and sex (P = 0.87) between the two groups. Compared to the anticoagulation group, the PIH group had a higher incidence of END recovery (77.2% vs. 51.5%, P < 0.01) and excellent outcomes (34.2% vs. 16.2%, P = 0.04). PIH was associated with END (HR 2.49; 95% CI 1.06-5.81, P = 0.04). PIH remained associated with END recovery (adjusted HR 3.91; 95% CI 1.19-12.90, P = 0.02). Safety outcomes, like hemorrhagic conversion and mortality, were not significantly different between the two groups.
CONCLUSIONS
CONCLUSIONS
As a rescue therapy for the progression of END in lacunar stroke patients, PIH with phenylephrine was more effective with similar safety compared to anticoagulation with argatroban.
Identifiants
pubmed: 39244562
doi: 10.1186/s12883-024-03825-7
pii: 10.1186/s12883-024-03825-7
doi:
Substances chimiques
Anticoagulants
0
argatroban
IY90U61Z3S
Sulfonamides
0
Arginine
94ZLA3W45F
Antihypertensive Agents
0
Pipecolic Acids
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
329Informations de copyright
© 2024. The Author(s).
Références
Helleberg BH, Ellekjær H, Rohweder G, Indredavik B. Mechanisms, predictors and clinical impact of early neurological deterioration: the protocol of the Trondheim early neurological deterioration study. BMC Neurol. 2014;14:201.
doi: 10.1186/s12883-014-0201-4
Gwak DS, Kwon JA, Shim DH, Kim YW, Hwang YH. Perfusion and diffusion variables predict early neurological deterioration in minor stroke and large vessel occlusion. J Stroke. 2021;23:61–8.
doi: 10.5853/jos.2020.01466
Park SH, Kim TJ, Jeong HB, Ko SB. Lack of association between low cumulative dose of hydroxyethyl starch and acute kidney injury in patients with acute ischemic stroke. J Korean Med Sci. 2020;35:e325.
doi: 10.3346/jkms.2020.35.e325
Kim SH, Jeon ET, Yu S, Oh K, Kim CK, Song TJ, et al. Interpretable machine learning for early neurological deterioration prediction in atrial fibrillation-related stroke. Sci Rep. 2021;11:20610.
doi: 10.1038/s41598-021-99920-7
Siegler JE, Samai A, Semmes E, Martin-Schild S. Early neurologic deterioration after stroke depends on vascular territory and stroke etiology. J Stroke. 2016;18:203–10.
doi: 10.5853/jos.2016.00073
Zhang M, Zhu W, Ma Y, Huang K, Huang S, Chen Q, et al. Early neurological deterioration and hypoperfusion volume ratio on arterial spin labeling in patients with Acute ischemic stroke. J Stroke Cerebrovasc Dis. 2021;30:105885.
doi: 10.1016/j.jstrokecerebrovasdis.2021.105885
Aichner FT, Fazekas F, Brainin M, Pölz W, Mamoli B, Zeiler K. Hypervolemic hemodilution in acute ischemic stroke: the Multicenter Austrian Hemodilution Stroke Trial (MAHST). Stroke. 1998;29:743–9.
doi: 10.1161/01.STR.29.4.743
Barron ME, Wilkes MM, Navickis RJ. A systematic review of the comparative safety of colloids. Arch Surg. 2004;139:552–63.
doi: 10.1001/archsurg.139.5.552
Woessner R, Grauer MT, Dieterich HJ, Bepperling F, Baus D, Kahles T, et al. Influence of a long-term, high-dose volume therapy with 6% hydroxyethyl starch 130/0.4 or crystalloid solution on hemodynamics, rheology and hemostasis in patients with acute ischemic stroke. Results of a randomized, placebo-controlled, double-blind study. Pathophysiol Haemost Thromb. 2003;33:121–6.
doi: 10.1159/000077819
Myburgh JA, Finfer S, Bellomo R, Billot L, Cass A, Gattas D, et al. Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012;367:1901–11.
doi: 10.1056/NEJMoa1209759
Perner A, Haase N, Guttormsen AB, Tenhunen J, Klemenzson G, Åneman A, et al. Hydroxyethyl starch 130/0.42 versus Ringer’s acetate in severe sepsis. N Engl J Med. 2012;367:124–34.
doi: 10.1056/NEJMoa1204242
Lee MH, Kim JG, Jeon SB, Kang DW, Kwon SU, Kim JS. Pharmacologically induced hypertension therapy for acute stroke patients. J Stroke. 2019;21:228–30.
doi: 10.5853/jos.2019.00437
Bang OY, Chung JW, Kim SK, Kim SJ, Lee MJ, Hwang J, et al. Therapeutic-induced hypertension in patients with noncardioembolic acute stroke. Neurology. 2019;93:e1955–63.
doi: 10.1212/WNL.0000000000008520
LaMonte MP, Nash ML, Wang DZ, Woolfenden AR, Schultz J, Hursting MJ, et al. Argatroban anticoagulation in patients with acute ischemic stroke (ARGIS-1): a randomized, placebo-controlled safety study. Stroke. 2004;35:1677–82.
doi: 10.1161/01.STR.0000131549.20581.ba
Zhou LS, Li XQ, Zhou ZH, Chen HS. Effect of Argatroban Combined with Dual Antiplatelet Therapy on early neurological deterioration in Acute minor posterior circulation ischemic stroke. Clin Appl Thromb Hemost. 2020;26:1076029620904131.
doi: 10.1177/1076029620904131
Wang PF, Sun ZR, Yu JC, Geng N, Liu LY, Zhu LN, et al. Early argatroban and antiplatelet combination therapy in acute non-lacunar single subcortical infarct associated with mild intracranial atherosclerosis. BMC Neurol. 2021;21:440.
doi: 10.1186/s12883-021-02435-x
Huang P, He XY, Xu M. Effect of Argatroban Injection on Clinical Efficacy in patients with Acute Cerebral infarction: preliminary findings. Eur Neurol. 2021;84:38–42.
doi: 10.1159/000512813
National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.
doi: 10.1056/NEJM199512143332401
Serena J, Leira R, Castillo J, Pumar JM, Castellanos M, Dávalos A. Neurological deterioration in acute lacunar infarctions: the role of excitatory and inhibitory neurotransmitters. Stroke. 2001;32:1154–561.
doi: 10.1161/01.STR.32.5.1154
Berberich A, Schneider C, Herweh C, Hielscher T, Reiff T, Bendszus M, et al. Risk factors associated with progressive lacunar strokes and benefit from dual antiplatelet therapy. Eur J Neurol. 2020;27:817–24.
doi: 10.1111/ene.14159
Hong KS, Kang DW, Koo JS, Yu KH, Han MK, Cho YJ, et al. Impact of neurological and medical complications on 3-month outcomes in acute ischaemic stroke. Eur J Neurol. 2008;15:1324–31.
doi: 10.1111/j.1468-1331.2008.02310.x
Weimar C, Mieck T, Buchthal J, Ehrenfeld CE, Schmid E, Diener HC, et al. Neurologic worsening during the acute phase of ischemic stroke. Arch Neurol. 2005;62:393–7.
doi: 10.1001/archneur.62.3.393
Johnston SC, Easton JD, Farrant M, Barsan W, Battenhouse H, Conwit R, et al. Platelet-oriented inhibition in new TIA and minor ischemic stroke (POINT) trial: rationale and design. Int J Stroke. 2013;8:479–83.
doi: 10.1111/ijs.12129
Kim HJ, Kang DW. Induced hypertensive therapy in an acute ischemic stroke patient with early neurological deterioration. J Clin Neurol. 2007;3:187–91.
doi: 10.3988/jcn.2007.3.4.187
Bevan JA, Duckworth J, Laher I, Oriowo MA, McPherson GA, Bevan RD. Sympathetic control of cerebral arteries: specialization in receptor type, reserve, affinity, and distribution. FASEB J. 1987;1:193–8.
doi: 10.1096/fasebj.1.3.2887477
Barreto AD, Ford GA, Shen L, Pedroza C, Tyson J, Cai C, et al. Randomized, Multicenter Trial of ARTSS-2 (Argatroban with recombinant tissue plasminogen activator for Acute Stroke). Stroke. 2017;48:1608–16.
doi: 10.1161/STROKEAHA.117.016720
Berekashvili K, Soomro J, Shen L, Misra V, Chen PR, Blackburn S, et al. Safety and feasibility of Argatroban, recombinant tissue plasminogen activator, and intra-arterial therapy in Stroke (ARTSS-IA Study). J Stroke Cerebrovasc Dis. 2018;27:3647–51.
doi: 10.1016/j.jstrokecerebrovasdis.2018.08.036
Rubin DB. Estimating causal effects from large data sets using propensity scores. Ann Intern Med. 1997;127(8 Pt 2):757–63.
doi: 10.7326/0003-4819-127-8_Part_2-199710151-00064
Campbell BC, Christensen S, Tress BM, Churilov L, Desmond PM, Parsons MW, et al. Failure of collateral blood flow is associated with infarct growth in ischemic stroke. J Cereb Blood Flow Metab. 2013;33:1168–72.
doi: 10.1038/jcbfm.2013.77
Liebeskind DS, Tomsick TA, Foster LD, Yeatts SD, Carrozzella J, Demchuk AM, et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke. 2014;45:759–64.
doi: 10.1161/STROKEAHA.113.004072
Nam HS, Scalzo F, Leng X, Ip HL, Lee HS, Fan F, et al. Hemodynamic impact of systolic blood pressure and hematocrit calculated by Computational Fluid Dynamics in patients with intracranial atherosclerosis. J Neuroimaging. 2016;26:331–8.
doi: 10.1111/jon.12314
Jiang B, Churilov L, Kanesan L, Dowling R, Mitchell P, Dong Q, et al. Blood pressure may be Associated with arterial collateralization in anterior circulation ischemic stroke before Acute Reperfusion Therapy. J Stroke. 2017;19:222–8.
doi: 10.5853/jos.2016.01739
Rose JC, Mayer SA. Optimizing blood pressure in neurological emergencies. Neurocrit Care. 2004;1:287–99.
doi: 10.1385/NCC:1:3:287
Ogoh S, Sato K, Fisher JP, Seifert T, Overgaard M, Secher NH. The effect of phenylephrine on arterial and venous cerebral blood flow in healthy subjects. Clin Physiol Funct Imaging. 2011;31:445–51.
doi: 10.1111/j.1475-097X.2011.01040.x
Edvinsson L, Owman C, Sjöberg NO. Autonomic nerves, mast cells, and amine receptors in human brain vessels. A histochemical and pharmacological study. Brain Res. 1976;115:377–93.
doi: 10.1016/0006-8993(76)90356-5
Alawneh JA, Moustafa RR, Baron JC. Hemodynamic factors and perfusion abnormalities in early neurological deterioration. Stroke. 2009;40:e443–50.
doi: 10.1161/STROKEAHA.108.532465
Lyden P, Pereira B, Chen B, Zhao L, Lamb J, Lei IF, et al. Direct thrombin inhibitor argatroban reduces stroke damage in 2 different models. Stroke. 2014;45:896–9.
doi: 10.1161/STROKEAHA.113.004488
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with Acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of Acute ischemic stroke: a Guideline for Healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50:e344–418.
doi: 10.1161/STR.0000000000000211
Sandercock PA, Counsell C, Kane EJ. Anticoagulants for acute ischaemic stroke. Cochrane Database Syst Rev. 2015;2015:CD000024.
Whiteley WN, Adams HP Jr, Bath PM, Berge E, Sandset PM, Dennis M, et al. Targeted use of heparin, heparinoids, or low-molecular-weight heparin to improve outcome after acute ischaemic stroke: an individual patient data meta-analysis of randomised controlled trials. Lancet Neurol. 2013;12:539–45.
doi: 10.1016/S1474-4422(13)70079-6
Rordorf G, Cramer SC, Efird JT, Schwamm LH, Buonanno F, Koroshetz WJ. Pharmacological elevation of blood pressure in acute stroke. Clinical effects and safety. Stroke. 1997;28:2133–8.
doi: 10.1161/01.STR.28.11.2133
Rordorf G, Koroshetz WJ, Ezzeddine MA, Segal AZ, Buonanno FS. A pilot study of drug-induced hypertension for treatment of acute stroke. Neurology. 2001;56:1210–3.
doi: 10.1212/WNL.56.9.1210
Hillis AE, Ulatowski JA, Barker PB, Torbey M, Ziai W, Beauchamp NJ, et al. A pilot randomized trial of induced blood pressure elevation: effects on function and focal perfusion in acute and subacute stroke. Cerebrovasc Dis. 2003;16:236–46.
doi: 10.1159/000071122
Lim TS, Hong JM, Lee JS, Shin DH, Choi JY, Huh K. Induced-hypertension in progressing lacunar infarction. J Neurol Sci. 2011;308(1–2):72–6.
doi: 10.1016/j.jns.2011.06.009
Kang MJ, Yang JW, Lee YB, Park KH, Park HM, Shin DJ, et al. The role of phenylephrine in patients with small deep subcortical infarct and progressive weakness. J Neurol Sci. 2017;377:107–11.
doi: 10.1016/j.jns.2017.04.008
Koenig MA, Geocadin RG, de Grouchy M, Glasgow J, Vimal S, Restrepo L, et al. Safety of induced hypertension therapy in patients with acute ischemic stroke. Neurocrit Care. 2006;4:3–7.
doi: 10.1385/NCC:4:1:003
Lewis BE, Wallis DE, Leya F, Hursting MJ, Kelton JG, et al. Argatroban anticoagulation in patients with heparin-induced thrombocytopenia. Arch Intern Med. 2003;163:1849–56.
doi: 10.1001/archinte.163.15.1849
Schwarz S, Georgiadis D, Aschoff A, Schwab S. Effects of induced hypertension on intracranial pressure and flow velocities of the middle cerebral arteries in patients with large hemispheric stroke. Stroke. 2002;33:998–1004.
doi: 10.1161/01.STR.0000014584.17714.2E