BACKGROUND: Thrombolysis for acute stroke is beneficial in selected patients. Because clinical trials generally exclude patients with pre-existing disability, this subgroup of patients has not been studied. We examined the outcomes after thrombolysis of patients with and without disability before their stroke. METHODS: We prospectively followed 112 consecutive patients with acute ischemic stroke who were given intravenous thrombolysis treatment according to published protocols. Three-month outcomes of the patients with pre-existing disability (defined as a prestroke score of 2 or more on the modified Rankin scale [MRS]) were compared with those of patients without pre-existing disability (defined as a prestroke MRS score of 0 or 1) and with those of 168 patients similarly treated in the National Institute of Neurological Disorders and Stroke trial. RESULTS: At 3 months after the stroke, patients with pre-existing disability (21% of the 112) had a higher mortality rate than those without (33% v. 14%) (odds ratio 3.2, 95% confidence interval 1.0-10.1) and worse function (median MRS score 3 v. 2, p = 0.03). However, there was little difference between the 2 groups in neurologic impairment among the survivors (median score on the National Institutes of Health stroke scale 4 v. 2, p = 0.41) or in the total proportion of those with an MRS score of 0 or 1 or, for those with a prestroke score greater than 1, a return to the prestroke score (42% v. 41%, p = 0.87). INTERPRETATION: Although the true effectiveness of thrombolysis for acute stroke in patients with pre-existing disability is not known, treated patients appear able to return to their prestroke level of function as often as patients without pre-existing disability, despite a significantly higher mortality rate.
BACKGROUND: Thrombolysis for acute stroke is beneficial in selected patients. Because clinical trials generally exclude patients with pre-existing disability, this subgroup of patients has not been studied. We examined the outcomes after thrombolysis of patients with and without disability before their stroke. METHODS: We prospectively followed 112 consecutive patients with acute ischemic stroke who were given intravenous thrombolysis treatment according to published protocols. Three-month outcomes of the patients with pre-existing disability (defined as a prestroke score of 2 or more on the modified Rankin scale [MRS]) were compared with those of patients without pre-existing disability (defined as a prestroke MRS score of 0 or 1) and with those of 168 patients similarly treated in the National Institute of Neurological Disorders and Stroke trial. RESULTS: At 3 months after the stroke, patients with pre-existing disability (21% of the 112) had a higher mortality rate than those without (33% v. 14%) (odds ratio 3.2, 95% confidence interval 1.0-10.1) and worse function (median MRS score 3 v. 2, p = 0.03). However, there was little difference between the 2 groups in neurologic impairment among the survivors (median score on the National Institutes of Health stroke scale 4 v. 2, p = 0.41) or in the total proportion of those with an MRS score of 0 or 1 or, for those with a prestroke score greater than 1, a return to the prestroke score (42% v. 41%, p = 0.87). INTERPRETATION: Although the true effectiveness of thrombolysis for acute stroke in patients with pre-existing disability is not known, treated patients appear able to return to their prestroke level of function as often as patients without pre-existing disability, despite a significantly higher mortality rate.
Authors: B Silver; B Demaerschalk; J G Merino; E Wong; A Tamayo; A Devasenapathy; C O'Callaghan; A Kertesz; G B Young; A J Fox; J D Spence; V Hachinski Journal: Can J Neurol Sci Date: 2001-05 Impact factor: 2.104
Authors: T Brott; H P Adams; C P Olinger; J R Marler; W G Barsan; J Biller; J Spilker; R Holleran; R Eberle; V Hertzberg Journal: Stroke Date: 1989-07 Impact factor: 7.914
Authors: Sanjana Salwi; Shawna Cutting; Alan D Salgado; Kiersten Espaillat; Matthew R Fusco; Michael T Froehler; Rohan V Chitale; Howard Kirshner; Matthew Schrag; Adam Jasne; Tina Burton; Brian MacGrory; Ali Saad; Mahesh V Jayaraman; Tracy E Madsen; Katarina Dakay; Ryan McTaggart; Shadi Yaghi; Pooja Khatri; Akshitkumar M Mistry; Eva A Mistry Journal: Stroke Date: 2020-04-09 Impact factor: 7.914
Authors: Terence J Quinn; Martin Taylor-Rowan; Aishah Coyte; Allan B Clark; Stanley D Musgrave; Anthony K Metcalf; Diana J Day; Max O Bachmann; Elizabeth A Warburton; John F Potter; Phyo Kyaw Myint Journal: Front Neurol Date: 2017-06-13 Impact factor: 4.003
Authors: Justyna M Derbisz; Marcin Wnuk; Tadeusz Popiela; Jeremiasz Jagiełła; Roman Pułyk; Joanna Słowik; Tomasz Dziedzic; Wojciech Turaj; Agnieszka Słowik Journal: Pol J Radiol Date: 2021-06-11