Clinical Risk Factors Associated with Ambulatory Outcome in Acute Ischemic Stroke Patients Smokers Treated with Thrombolytic Therapy

Abstract Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy. Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions. Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions. Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.

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Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours: Predicting clinical risk factors for thrombolytic therapy

10.21203/rs.2.17137/v1 ◽

2019 ◽

Author(s):

Nicolas Poupore ◽

Dan Strat ◽

Tristan Mackey ◽

Ashley Snell ◽

Thomas Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Older Patients ◽

Clinical Risk Factors ◽

Receiver Operating Curve ◽

Stroke Patients ◽

Clinical Risk ◽

Stroke Population ◽

Clinical Risks

Abstract Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

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Cholesterol reducer and Thrombolytic therapy in acute ischemic stroke

10.21203/rs.2.20629/v1 ◽

2020 ◽

Author(s):

Nicolas Poupore ◽

Dan Strat ◽

Tristan Mackey ◽

Katherine Brown ◽

Ashley Snell ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Demographic Data ◽

Recombinant Tissue Plasminogen Activator ◽

Clinical Risk Factors ◽

Medication History ◽

Factors Associated ◽

Clinical Risk

Abstract Background Specific clinical risk factors may contribute to worsening or improving neurological functions in an acute ischemic stroke (AIS) patient pre-treated with a cholesterol reducer with a subsequent recombinant tissue plasminogen activator (rtPA) treatment. We investigated clinical risk factors associated with good or poor presenting neurological symptoms in ischemic stroke patients with prior cholesterol reducer use, specifically a statin and rtPA therapy.Methods We retrospectively analyzed baseline clinical and demographic data of 630 patients with AIS taking cholesterol reducers prior to rtPA treatment from January 2010 to June 2016 in a regional stroke center. Progressing (NIHSS ≤ 7) or worsening (NIHSS > 7) scores for neurologic improvement determined measures for treatment outcome. Multivariate logistic regression models identified demographic and clinical factors associated with worsening or progressing neurologic functions.Results Adjusted multivariate analysis showed that in an ischemic stroke population with a combined rtPA and cholesterol reducer medication history, increasing age (OR = 1.032, 95% CI, 1.015-1.048, P < 0.001) and atrial fibrillation (OR = 1.859, 95% CI, 1.098-3.149, P = 0.021) demonstrated a likely association with worsening neurologic functions, while direct admission (OR = 0.411, 95% CI, 0.246-0.686, P = 0.001) and being Caucasian (OR = 0.496, 95% CI, 0.297-0.827, P = 0.007) showed an association with improving or progressing neurologic functions.Conclusion A prior cholesterol reducer, namely a statin, plus rtPA combination may be associated with worsening neurological function for elderly AIS patients with atrial fibrillation, while Caucasians directly admitted to a neurology unit are more likely to show an association with progress or improvements in neurologic functions.

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Can clinical risk factors predict functional recovery in ischemic stroke patients with pre-stroke depression?

10.21203/rs.2.10087/v1 ◽

2019 ◽

Author(s):

Leah Wormack ◽

Brice Blum ◽

Benjamin Bailes ◽

Thomas Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Outcome ◽

Clinical Risk Factors ◽

Stroke Patients ◽

Antihypertensive Medications ◽

Clinical Risk ◽

Predictive Variables ◽

Stroke Population ◽

Thrombolysis Therapy

Abstract Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

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Clinical risk factors associated with recurrence of ischemic stroke within two years

Medicine ◽

10.1097/md.0000000000020830 ◽

2020 ◽

Vol 99 (26) ◽

pp. e20830

Author(s):

Yuanyuan Zhuo ◽

Jiaman Wu ◽

Yimin Qu ◽

Haibo Yu ◽

Xingxian Huang ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Clinical Risk Factors ◽

Factors Associated ◽

Clinical Risk

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Abstract P077: Hypertension And Ischemic Stroke; The Effect Of A Combined Anti-hypertension Medications And Thrombolytic Therapy

Hypertension ◽

10.1161/hyp.76.suppl_1.p077 ◽

2020 ◽

Vol 76 (Suppl_1) ◽

Author(s):

Nicolas Poupore ◽

Bridgette Allen ◽

Thomas I Nathaniel

Keyword(s):

Risk Factors ◽

Logistic Regression ◽

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Characteristic Curve ◽

Management Strategies ◽

Recombinant Tissue Plasminogen Activator ◽

Clinical Risk Factors ◽

High Density Lipoproteins ◽

Clinical Risk

Background: The aim of this study is to identify clinical risk factors in acute ischemic stroke ( AIS) pretreated with anti-hypertensive (anti-HTN) medications with a subsequent thrombolytic therapy that are associated with potential worsening or improving neurological functions. Methods: We analyzed retrospectively collected data from consecutive AIS patients with a combined anti-HTN medications and recombinant tissue plasminogen activator (rtPA) therapy for AIS. We used logistic regression model to identify demographic and clinical risk factors that are associated with improving or worsening neurologic functions in AIS patients with a combined anti-HTN and thrombolytic therapy. The overall correct classification of the logistic regression models was determined using the Hosmer-Lemeshow test, while the area under the receiver operating characteristic curve was used to test the sensitivity of the model. The variance inflation factor was used to check for multicollinearity. Results: In the adjusted analysis, patients with increasing age (Odd ratio (OR)=1.035, 95% CI, 1.022-1.049, P <0.001), female AIS patients (OR = 1.630, 95% CI, 1.182-2.248, P =0.002) with a history of substance abuse (OR = 2.315, 95% CI, 1.107-4.842, P = 0.026) were associated with worsening neurologic functions. However, Caucasians (OR = 0.535, 95% CI, 0.361-0.793, P = 0.002) with dyslipidemia (OR = 0.655, 95% CI, 0.479-0.897, P = 0.008), obesity (OR = 0.642, 95% CI, 0.472-0.873, P = 0.005), high-density lipoproteins (HDL; OR = 0.988, 95% CI, 0.976-1.000, P = 0.045), and with a direct admission (OR = 0.509, 95% CI, 0.341-0.761, P = 0.001) were associated with improving neurologic function in AIS patients with a combined anti-HTN medications and rtPA therapy. Conclusion: Our findings reveal specific demographic and clinical risk factors that are associated with worsening or improving neurological functions in AIS pretreated anti-HTN medications with a subsequent thrombolytic therapy. This finding suggests the development of management strategies to manage identified clinical risk factors in AIS patients pretreated with anti-HTN medications prior to thrombolytic therapy.

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Clinical Risk Factors that Predict Functional Recovery in Ischemic Stroke Patients with Pre-Stroke Depression

10.20944/preprints201906.0048.v1 ◽

2019 ◽

Author(s):

Leah Wormack ◽

Brice Blum ◽

Benjamin Bailes ◽

Thomas Nathaniel

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Functional Outcome ◽

Clinical Risk Factors ◽

Stroke Patients ◽

Antihypertensive Medications ◽

Clinical Risk ◽

Predictive Variables ◽

Stroke Population ◽

Thrombolysis Therapy

Background. Specific clinical risk factors that may be associated with ambulatory outcome following thrombolysis therapy in ischemic stroke patients with pre-stroke depression is not fully understood. This was investigated. Methods. Multivariate analyses were performed to identify predictors of functional ambulatory outcomes. Patient demographics and clinical risk factors served as predictive variables, while improvement or no improvement in ambulatory outcome was considered as the primary outcome. Results. A total of 595 of these patients received rtPA of which 310 patients presented with pre-stroke depression, 217 had no improvement in functional outcome, while 93 patients presented with an improvement in functional outcome. Carotid artery stenosis (OR= 11.577, 95% CI, 1.281 – 104.636, P=0.029) and peripheral vascular disease (OR= 18.040, 95% CI, 2.956-110.086, P=0.002) were more likely to be associated with an improvement in ambulation. Antihypertensive medications (OR= 7.810, 95% CI, 1.401 –43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 –0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 –0.402, P=0.030) were associated with a no improvement in ambulation. Conclusion. After adjustment for covariates, more clinical risk factors were associated with no improvement when compared with improvement in functional outcome following thrombolysis therapy in an acute ischemic stroke population with pre-stroke depression.

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Abstract 1122‐000161: Clinical Factors Associated with rtPA Inclusion in Ischemic Stroke Patients with and without Heart Failure

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000161 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Carolyn B Sanders ◽

Camron Edrissi ◽

Chase Rathfoot ◽

Krista Knisely ◽

Nicolas Poupore ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Ischemic Stroke ◽

Coronary Artery ◽

Clinical Risk Factors ◽

Clinical Factors ◽

Factors Associated ◽

Clinical Risk ◽

Direct Admission ◽

Stroke Center

Introduction : It is estimated that approximately 10–24% of acute ischemic stroke (AIS) patients have comorbid heart failure (HF). However, it is currently unknown if certain clinical risk factors associated with rtPA thrombolytic therapy differ based on HF diagnosis. The purpose of this study is to determine the clinical factors associated with rtPA inclusion in AIS patients with and without heart failure. Methods : Retrospective data for baseline clinical and demographic factors from January 2010 to January 2016 in a regional stroke center were analyzed. Of the 5,469 patients identified with AIS, 590 presented with heart failure while 4,879 did not. Odds ratios and 95% confidence intervals were used to determine which clinical factors were associated with rtPA inclusion. Results : Adjusted multivariate analysis demonstrated that within the AIS population, those without HF who received rtPA were more likely to be associated with Hispanic ethnicity (OR = 0.464, 95% CI, 0.247‐0.87, P = 0.017), coronary artery stenosis (OR = 0.55, 95% CI, 0.366‐0.83, P = 0.004), previous stroke (OR = 0.745, 95% CI, 0.609‐0.91, P = 0.004), previous TIA (OR = 1.447, 95% CI, 1.094‐1.91, P = 0.010), total cholesterol (OR = 1.487, 95% CI, 1.175‐1.88, P = 0.001), lipids (OR = 0.998, 95% CI, 0.996‐1, P = 0.038), serum creatinine (OR = 0.899, 95% CI, 0.854‐0.95, P<0.001), INR (OR = 0.825, 95% CI, 0.73‐0.93, P = 0.002), heart rate (OR = 0.13, 95% CI, 0.071‐0.24, P<0.001), and direct admission (OR = 2.87, 95% CI, 2.432‐3.39, P<0.001). AIS patients with HF who received rtPA were more likely to be associated with increasing age (OR = 0.982, 95% CI, 0.966‐1, P = 0.020), coronary artery disease (OR = 0.618, 95% CI, 0.391‐0.98, P = 0.0.040), INR (OR = 0.326, 95% CI, 0.129‐0.82, P = 0.018), and ambulatory improvement (OR = 1.69, 95% CI, 1.058‐2.7, P = 0.0.028). Conclusions : The results of this study demonstrate that within the AIS population, there are certain clinical risk factors that influence the likelihood of receiving rtPA in patients with and without HF. These findings provide further insight into AIS and HF and suggest the need for further research into the role the identified factors play in influencing clinical outcome.

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