BACKGROUND: The aim of this study was to determine whether renal dysfunction affects the outcome of stroke patients treated with recombinant tissue plasminogen activator (rt-PA). METHODS: A retrospective, multicenter, observational study was conducted to identify the effects of underlying risk factors on intravenous rt-PA therapy using 0.6 mg/kg alteplase in 10 stroke centers in Japan. Consecutive stroke patients with a premorbid modified Rankin Scale (mRS) score ≤3 who received rt-PA were studied. Renal dysfunction was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² on admission. The outcome measures were any intracerebral hemorrhage (ICH) and symptomatic ICH within the initial 36 h; favorable (mRS 0-1) outcome, poor outcome (mRS 4-6) and mortality at 3 months. RESULTS: Of a total of 578 patients (372 men; 64.4%, 71.4 ± 11.7 years old), renal dysfunction was present in 186 patients (32.2%). These patients were older and more commonly had hypertension, atrial fibrillation, prior ischemic heart disease and prior use of antithrombotic agents than patients without renal dysfunction. ICH (27.4 vs. 16.6%) and symptomatic ICH (8.1 vs. 2.6%) was more common in patients with renal dysfunction than in those without. At 3 months, patients with renal dysfunction had higher median mRS scores than those without (3 vs. 2). After multivariate adjustment for established outcome predictors, renal dysfunction was related to any ICH (odds ratio 1.81, 95% confidence interval 1.16-2.84), symptomatic ICH (2.64, 1.10-6.56), poor outcome (1.55, 1.01-2.38), and mortality (2.94, 1.38-6.42). CONCLUSIONS: Reduced eGFR was associated with early ICH and 3-month unfavorable outcome in stroke patients receiving intravenous rt-PA.
BACKGROUND: The aim of this study was to determine whether renal dysfunction affects the outcome of strokepatients treated with recombinant tissue plasminogen activator (rt-PA). METHODS: A retrospective, multicenter, observational study was conducted to identify the effects of underlying risk factors on intravenous rt-PA therapy using 0.6 mg/kg alteplase in 10 stroke centers in Japan. Consecutive strokepatients with a premorbid modified Rankin Scale (mRS) score ≤3 who received rt-PA were studied. Renal dysfunction was defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² on admission. The outcome measures were any intracerebral hemorrhage (ICH) and symptomatic ICH within the initial 36 h; favorable (mRS 0-1) outcome, poor outcome (mRS 4-6) and mortality at 3 months. RESULTS: Of a total of 578 patients (372 men; 64.4%, 71.4 ± 11.7 years old), renal dysfunction was present in 186 patients (32.2%). These patients were older and more commonly had hypertension, atrial fibrillation, prior ischemic heart disease and prior use of antithrombotic agents than patients without renal dysfunction. ICH (27.4 vs. 16.6%) and symptomatic ICH (8.1 vs. 2.6%) was more common in patients with renal dysfunction than in those without. At 3 months, patients with renal dysfunction had higher median mRS scores than those without (3 vs. 2). After multivariate adjustment for established outcome predictors, renal dysfunction was related to any ICH (odds ratio 1.81, 95% confidence interval 1.16-2.84), symptomatic ICH (2.64, 1.10-6.56), poor outcome (1.55, 1.01-2.38), and mortality (2.94, 1.38-6.42). CONCLUSIONS: Reduced eGFR was associated with early ICH and 3-month unfavorable outcome in strokepatients receiving intravenous rt-PA.
Authors: Paulus Kirchhof; Gregory Y H Lip; Isabelle C Van Gelder; Jeroen Bax; Elaine Hylek; Stefan Kaab; Ulrich Schotten; Karl Wegscheider; Giuseppe Boriani; Axel Brandes; Michael Ezekowitz; Hans Diener; Laurent Haegeli; Hein Heidbuchel; Deirdre Lane; Luis Mont; Stephan Willems; Paul Dorian; Maria Aunes-Jansson; Carina Blomstrom-Lundqvist; Maria Borentain; Stefanie Breitenstein; Martina Brueckmann; Nilo Cater; Andreas Clemens; Dobromir Dobrev; Sergio Dubner; Nils G Edvardsson; Leif Friberg; Andreas Goette; Michele Gulizia; Robert Hatala; Jenny Horwood; Lukas Szumowski; Lukas Kappenberger; Josef Kautzner; Angelika Leute; Trudie Lobban; Ralf Meyer; Jay Millerhagen; John Morgan; Felix Muenzel; Michael Nabauer; Christoph Baertels; Michael Oeff; Dieter Paar; Juergen Polifka; Ursula Ravens; Ludger Rosin; W Stegink; Gerhard Steinbeck; Panos Vardas; Alphons Vincent; Maureen Walter; Günter Breithardt; A John Camm Journal: Europace Date: 2011-07-26 Impact factor: 5.214
Authors: Santiago Palacio; Nicole R Gonzales; Navdeep S Sangha; Lee A Birnbaum; Robert G Hart Journal: Clin J Am Soc Nephrol Date: 2011-03-10 Impact factor: 8.237