Angioedema associated with thrombolysis for ischemic stroke: analysis of a case‐control study (original) (raw)
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Thrombolysis in Ischemic Stroke Without Arterial Occlusion at Presentation
Stroke, 2014
Background and Purpose-None of the randomized trials of intravenous tissue-type plasminogen activator reported vascular imaging acquired before thrombolysis. Efficacy of tissue-type plasminogen activator in stroke without arterial occlusion on vascular imaging remains unknown and speculative. Methods-We performed a retrospective, multicenter study to collect data of patients who presented to participating centers during a 5-year period with ischemic stroke diagnosed by clinical examination and MRI and with imaging evidence of no vascular occlusion. These patients were divided into 2 groups: those who received thrombolytic therapy and those who did not. Primary outcome measure of the study was excellent clinical outcome defined as modified Rankin Scale of 0 to 1 at 90 days from stroke onset. Secondary outcome measures were good clinical outcome (modified Rankin Scale, 0-2) and perfect outcome (modified Rankin Scale, 0). Safety outcome measures were incidence of symptomatic intracerebral hemorrhage and poor outcome (modified Rankin Scale, 4-6). Results-A total of 256 patients met study criteria, 103 with thrombolysis and 153 without. Logistic regression analysis showed that patients who received thrombolysis had more frequent excellent outcomes with odds ratio of 3.79 (P<0.01). Symptomatic intracerebral hemorrhage was more frequent in thrombolysis group (4.9 versus 0.7%; P=0.04). Thrombolysis led to more frequent excellent outcome in nonlacunar group with odds ratio 4.90 (P<0.01) and more frequent perfect outcome in lacunar group with odds ratio 8.25 (P<0.01). Conclusions-This study provides crucial data that patients with ischemic stroke who do not have visible arterial occlusion at presentation may benefit from thrombolysis.
Thrombolysis in Acute Ischemic Stroke
The Journal of the American Board of Family Medicine, 1998
BasedApproach to Drug Therapy. These articles are designed to provide concise answers to the drog therapy questions that family physicians encounter in their daily practice. The format of the feature will follow the mnemonic STEP: safety (an analysis of adverse effects that patients and providers care about), tolerability (pooled dropout rates from large clinical trials), effectiveness (how well the drogs work and in what patient population[s]), and price (costs of drog, but also cost-effectiveness of therapy). 1 Hence, the name STEPped Care. Since the informatics pioneers at McMaster University introduced evidence-based medicine,2 Slawson and Shaugh-nessy3,4 have brought it to mainstream family medicine education and practice. This feature is designed to further the mission of searchingfor the truth in medical practice. Authors will provide information in a stroctured format that allows the readers to get to the meat of a therapeutic isSlle in a way that can help physicians (and patients) make informed decisions. The articks will discourage the use of disease-uriented evidence (DOE) to make treatment decisions. Exampks of Doer include blood pressure lowering, decreases in hemoglobin Ale> and so on. We will include studies that provide POEMspatient-oriented evidence that matters (myocardial infarctions, pain, strokes, mortality, ete)-with the goal of offering patients the most practical, appropriate, and scientifically substantiated therapies. Number needed to treat to observe benefit in a single patient will also be included as a way of defining advantages in terms that are relatively easy to understand. 5,6 At times this effort will be frustrating. Even as vast as the Stroke is the third leading cause of death in the United States. Although the mortality rate from stroke has decreased during the past 50 years, this trend may be ending. l The reasons for the change in stroke mortality are unclear, and many factors, including the aging of the population, might be involved. Medications improving both quality of life
Thrombolysis in ischemic strokes with no arterial occlusion
International Journal of Stroke, 2012
Rationale Twelve million people develop ischemic stroke each year world over and 30-40% of them do not have arterial occlusions at presentation. Trials conducted to study the efficacy of thrombolytic drug reported better outcome with use of thrombolytic drug but none studied the subtypes of ischemic strokes specifically and adequately. The subgroups of patients with no arterial occlusion at presentation continue to receive thrombolytic therapy without proven benefit and with some risk.
Intravenous thrombolysis for acute ischemic stroke patients presenting with mild symptoms
2013
Background-The safety and long-term outcome of systemic thrombolysis in patients receiving antiplatelet medications remain subjects of great clinical significance. The objective of this meta-analysis was to determine how prestroke antiplatelet therapy affects the risks and benefits of intravenous thrombolysis in patients with acute ischemic stroke. Methods and Results-A dual-reviewer search was conducted in PubMed and EMBASE databases through November 2015, from which 19 studies involving a total of 108 588 patients with acute ischemic stroke were identified based on preset inclusion criteria. Information on study designs, patient characteristics, exposures, outcomes, and adjusting confounders was extracted, and estimates were combined by using random-effects models. The pooled crude estimates suggested that taking long-term antiplatelet medications was associated with higher odds of symptomatic intracranial hemorrhage (odds ratio [OR] 1.70, 95% CI 1.47-1.97) and death (OR 1.46, 95% CI 1.22-1.75) and lower odds of favorable functional outcomes (OR 0.86, 95% CI 0.80-0.93). However, the combined confounder-adjusted results only confirmed a relatively weak positive association between prior antiplatelet therapy and symptomatic intracranial hemorrhage (OR 1.21, 95% CI 1.02-1.44) and demonstrated no significant relationship between antiplatelet therapy and the other 2 outcomes (favorable outcome OR 1.09, 95% CI 0.96-1.24; death OR 1.02, 95% CI 0.98-1.07). Subgroup analyses revealed that the associations between prestroke antiplatelet therapy and outcomes were dependent on time and antiplatelet agents. Conclusions-Patients with acute ischemic stroke receiving long-term antiplatelet medications were associated with greater risks of developing symptomatic intracranial hemorrhage after systemic thrombolysis. However, the overall independent association between prestroke antiplatelet therapy and unfavorable outcomes or mortality was insignificant.
2015
OBJECTIVE: to evaluate epidemiological and neurological disabilities at hospital admission and discharge of patients with acute ischemic stroke who underwent intravenous thrombolysis. METHODS: A longitudinal study conducted from January-August 2012 at the Cerebrovascular Accident Unit of the General Hospital of Fortaleza/Ceará. The National Institute of Health Stroke Scale and modified Rankin Scale were used at admission and discharge of patients treated with intravenous rt-PA. RESULTS: In all, 38 patients aged 27-87 years (SD±14.1) participated. Most were men (60.5%); had lowmedium education level (71.1%); hemiparesis (97.4%); lip deviation (71.1%); aphasia (42.1%) and impairment of the middle cerebral artery (89.5%). The mortality rate was 23.7% after three months. Aphasia had OR=7.8 for death, CI=1.345.1. There was statistical significance in the NIHSS (p<0.01) and MRS (p<0.01) scores when compared between admission and discharge. CONCLUSIONS: There was significant improvem...
Long-Term Effect of Intra-Arterial Thrombolysis in Stroke
Stroke, 2006
Background and Purpose— Thrombolysis has been shown to improve the 3-month outcome of patients with ischemic stroke, but knowledge of the long-term effect of thrombolysis is limited. Methods— The present study compares the long-term outcome of stroke patients who were treated with intra-arterial thrombolysis (IAT) using urokinase with the outcome of patients treated with aspirin. The modified Rankin Scale (mRS) was used to assess the outcome; 173 patients treated with IAT and 261 patients treated with aspirin from the Bernese Stroke Data Bank were eligible for the study. A matching algorithm taking into account patient age and stroke severity on admission (as measured by the National Institute of Health Stroke Scale [NIHSS]) was used to assemble an IAT and an aspirin group. Results— One hundred and forty-four patients treated with IAT and 147 patients treated with aspirin could be matched and included in the comparative analysis. The median NIHSS score was 14 in each group. At 2 yea...
Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients
Annals of Indian Academy of Neurology
Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance. To analyze the obstacles for thrombolysis in acute stroke patients. The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i) Failure of patient to recognize stroke symptoms, ii) patient's awareness of thrombolysis as a treatment modality for stroke, iii) failure of patient's relative to recognize stroke, iv) failure of primary care physician to recognize stroke, v) transport delays, vi) lack of neu...