Michal Karlinski1, Adam Kobayashi, Anna Czlonkowska, Robert Mikulik, Daniel Vaclavik, Miroslav Brozman, Viktor Svigelj, Laszlo Csiba, Klara Fekete, Janika Kõrv, Vida Demarin, Aleksandras Vilionskis, Dalius Jatuzis, Yakup Krespi, Niaz Ahmed, Nils Wahlgren. 1. From the Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (M.K., A.K., A.C.); Interventional Stroke Treatment Centre, Institute of Psychiatry and Neurology, Warsaw, Poland (A.K.); Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Poland (A.C.); International Clinical Research Center, Neurology Department, St Anne's Hospital in Brno, Brno, Czech Republic (R.M., D.V.); Neurology Department, University Hospital Nitra, Constantin Philosopher University, Nitra, Slovakia (M.B.); Department of Vascular Neurology and Neurological Intensive Care, University Medical Centre Ljubljana and Zdravstveni Nasveti, Slovenia (V.Š.); Department of Neurology, Medical and Health Science Center, University of Debrecen, Hungary (L.C., K.F.); Department of Neurology and Neurosurgery, University of Tartu, Estonia (J.K.); Medical Center Aviva, Zagreb, Croatia (V.D.); Department of Neurology and Neurosurgery, Vilnius University and Republican Vilnius University Hospital, Lithuania (A.V.); Department of Neurology and Neurosurgery, Faculty of Medicine, Vilnius University and Vilnius University Hospital Santariskiu Clinics, Lithuania (D.J.); Stroke Rehabilitation and Research Center, Memorial Sisli Hospital, Memorial Health Group Stroke Center, Istanbul, Turkey (Y.K.); and Department of Neurology, Karolinska University Hospital, Solna and Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (N.A., N.W.).
Abstract
BACKGROUND AND PURPOSE: Little is known about the effect of thrombolysis in patients with preexisting disability. Our aim was to evaluate the impact of different levels of prestroke disability on patients' profile and outcome after intravenous thrombolysis. METHODS: We analyzed the data of all stroke patients admitted between October 2003 and December 2011 that were contributed to the Safe Implementation of Treatments in Stroke-Eastern Europe (SITS-EAST) registry. Patients with no prestroke disability at all (modified Rankin Scale [mRS] score, 0) were used as a reference in multivariable logistic regression. RESULTS: Of 7250 patients, 5995 (82%) had prestroke mRS 0, 791 (11%) had prestroke mRS 1, 293 (4%) had prestroke mRS 2, and 171 (2%) had prestroke mRS≥3. Compared with patients with mRS 0, all other groups were older, had more comorbidities, and more severe neurological deficit on admission. There was no clear association between preexisting disability and the risk of symptomatic intracranial hemorrhage. Prestroke mRS 1, 2, and ≥3 were associated with increased risk of death at 3 months (odds ratio, 1.3, 2.0, and 2.6, respectively) and lower chance of achieving favorable outcome (achieving mRS 0-2 or returning to the prestroke mRS; 0.80, 0.41, 0.59, respectively). Patients with mRS≥3 and 2 had similar vascular profile and favorable outcome (34% versus 29%), despite higher mortality (48% versus 39%). CONCLUSIONS: Prestroke disability does not seem to independently increase the risk of symptomatic intracranial hemorrhage after thrombolysis. Despite higher mortality, 1 in 3 previously disabled patients may return to his/her prestroke mRS. Therefore, they should not be routinely excluded from thrombolytic therapy.
BACKGROUND AND PURPOSE: Little is known about the effect of thrombolysis in patients with preexisting disability. Our aim was to evaluate the impact of different levels of prestroke disability on patients' profile and outcome after intravenous thrombolysis. METHODS: We analyzed the data of all strokepatients admitted between October 2003 and December 2011 that were contributed to the Safe Implementation of Treatments in Stroke-Eastern Europe (SITS-EAST) registry. Patients with no prestroke disability at all (modified Rankin Scale [mRS] score, 0) were used as a reference in multivariable logistic regression. RESULTS: Of 7250 patients, 5995 (82%) had prestroke mRS 0, 791 (11%) had prestroke mRS 1, 293 (4%) had prestroke mRS 2, and 171 (2%) had prestroke mRS≥3. Compared with patients with mRS 0, all other groups were older, had more comorbidities, and more severe neurological deficit on admission. There was no clear association between preexisting disability and the risk of symptomatic intracranial hemorrhage. Prestroke mRS 1, 2, and ≥3 were associated with increased risk of death at 3 months (odds ratio, 1.3, 2.0, and 2.6, respectively) and lower chance of achieving favorable outcome (achieving mRS 0-2 or returning to the prestroke mRS; 0.80, 0.41, 0.59, respectively). Patients with mRS≥3 and 2 had similar vascular profile and favorable outcome (34% versus 29%), despite higher mortality (48% versus 39%). CONCLUSIONS:Prestroke disability does not seem to independently increase the risk of symptomatic intracranial hemorrhage after thrombolysis. Despite higher mortality, 1 in 3 previously disabled patients may return to his/her prestroke mRS. Therefore, they should not be routinely excluded from thrombolytic therapy.
Authors: Marek Sykora; Patrik Michel; Davide Strambo; Stefan Krebs; Julia Ferrari; Alexandra Posekany; Dominika Mikšová; Konstantin Hermann; Thomas Gattringer; Elke Gizewski; Hannes Deutschmann; Christian Neumann; Wilfried Lang Journal: J Stroke Date: 2022-09-30 Impact factor: 8.632
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: Eivind Berge; William Whiteley; Heinrich Audebert; Gian Marco De Marchis; Ana Catarina Fonseca; Chiara Padiglioni; Natalia Pérez de la Ossa; Daniel Strbian; Georgios Tsivgoulis; Guillaume Turc Journal: Eur Stroke J Date: 2021-02-19
Authors: Marco Franceschini; Stefania Fugazzaro; Maurizio Agosti; Carlotta Sola; Antonio Di Carlo; Lorenzo Cecconi; Salvatore Ferro Journal: Am J Phys Med Rehabil Date: 2018-07 Impact factor: 2.159
Authors: Andreas Kastrup; Christian Roth; Maria Politi; Maria Alexandrou; Helmut Hildebrandt; Andreas Schröter; Panagiotis Papanagiotou Journal: Front Neurol Date: 2021-06-02 Impact factor: 4.003
Authors: Eva Zupanic; Mia von Euler; Ingemar Kåreholt; Beatriz Contreras Escamez; Johan Fastbom; Bo Norrving; Dorota Religa; Milica G Kramberger; Bengt Winblad; Kristina Johnell; Maria Eriksdotter; Sara Garcia-Ptacek Journal: Neurology Date: 2017-10-06 Impact factor: 9.910