scholarly journals Effect of antihypertensive medications on thrombolysis therapy and outcomes in acute ischemic stroke patients

2019 ◽  
Vol 21 (2) ◽  
pp. 271-279 ◽  
Author(s):  
Tyler Fleming ◽  
Brice Blum ◽  
Benjamin Averkamp ◽  
James Sullivan ◽  
Thomas Nathaniel
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
Thrombolysis Therapy

Abstract MP86: Effects of Immediate Blood Pressure Reduction on Death and Major Disability in Acute Ischemic Stroke Patients by History of Hypertension and Use of Antihypertensive Medications

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Tan Xu ◽  
Yonghong Zhang ◽  
Yingxian Sun ◽  
Chung-Shiuan Chen ◽  
Jing Chen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Treatment Group ◽  
Acute Ischemic Stroke ◽  
Hospital Discharge ◽  
Odds Ratio ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Antihypertensive Medications ◽  
History Of

Introduction: The effects of blood pressure (BP) reduction on clinical outcomes among acute stroke patient remain uncertain. Hypothesis: We tested the effects of immediate BP reduction on death and major disability at 14 days or hospital discharge and 3-month follow-up in acute ischemic stroke patients with and without a previous history of hypertension or use of antihypertensive medications. Methods: The China Antihypertensive Trial in Acute Ischemic Stroke (CATIS) randomly assigned patients with ischemic stroke within 48 hours of onset and elevated systolic BP (SBP) to receive antihypertensive treatment (N=2,038) or to discontinue all antihypertensive medications (N=2,033) during hospitalization. Randomization was stratified by participating hospitals and use of antihypertensive medications. Study outcomes were assessed at 14 days or hospital discharge and 3-month post-treatment follow-up. The primary outcome was death and major disability (modified Rankin Scale score≥3), and secondary outcomes included recurrent stroke and vascular events. Results: Mean SBP was reduced 12.7% in the treatment group and 7.2% in the control group within 24 hours after randomization (P<0.001). Mean SBP was 137.3 mmHg in the treatment group and 146.5 in the control group at day 7 after randomization (P<0.001). At 14 days or hospital discharge, the primary and secondary outcomes were not significantly different between the treatment and control groups by subgroups. At the 3-month follow-up, recurrent stroke was significantly reduced in the antihypertensive treatment group among patients with a history of hypertension (odds ratio 0.43, 95% CI 0.24-0.75, P=0.003) and among patients with a history of use of antihypertensive medications (odds ratio 0.41, 95% CI 0.20-0.84, P=0.01). All-cause mortality (odds ratio 2.84, 95% CI 1.11-7.27, P=0.03) was increased among patients without a history of hypertension. Conclusion: Immediate BP reduction lowers recurrent stroke among acute ischemic stroke patients with a previous history of hypertension or use of antihypertensive medications at 3 months. On the other hand, BP reduction increases all-cause mortality among patients without a history of hypertension.

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

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.

Prognostic models for ambulatory recovery functions in acute ischemic stroke patients with thrombolysis therapy

2018 ◽  
Author(s):  
Matthew Scalise ◽  
Jordan Gainey ◽  
Benjamin Bailes ◽  
Leanne Brecthtel ◽  
Zachary Conn ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Prognostic Models ◽  
Broca's Aphasia ◽  
Stroke Patients ◽  
Motor Speech ◽  
Stroke Registry ◽  
Broca’S Aphasia ◽  
Thrombolysis Therapy

Abstract Background. The purpose of this study was to develop models to predict the recovery of ambulatory functions taking into account the capability of the motor system to functionally reorganize in response to thrombolysis therapy. Methods. We predicted ambulatory functions recovery using retrospective data from a stroke registry of acute ischemic stroke patients who received thrombolysis therapy. Multivariate regression was used to construct the models. Multicollinearity and significant interactions were examined using variance inflation factors, while a Cox & Snell classification were applied to check the fitness of each model. Results. The models correctly predicted clinical variables that were associated with an improvement or non-improvement in functional ambulatory outcome. Broca’s aphasia (OR = 2.270, P = 0.002, CI =1.34-3.83) was associated with improved functional outcome at discharge, while patients aged 80 years or older (OR = 0.942, P = <0.001, CI =0.92-0.96), patients with congestive heart failure (OR = 0.496, P = 0.040, CI = 0.25-0.97), higher NIHSS (OR=0.876, P = 0.001, CI = 0.80-0.95), taking antihypertensive medication (OR = 0.436, P = 0.023, CI = 0.21-0.89) were not associated with improved ambulatory functional outcome with thrombolysis. The discriminating ability for the model was 74.2% for the total population, 71.7% for the rtPA group, and 72.2% for the no-rtPA group indicating strong performance. Conclusion. Prognostic models that can predict improved functional ambulatory outcome in thrombolysis therapy can be beneficial in the care of stroke patients. Our models predicted improved functional recovery of Broca’s aphasia after thrombolysis therapy, suggesting a future potential to evaluate motor speech area after stroke.

Direct access to a hospital offering intravenous thrombolysis therapy improves functional outcome of acute ischemic stroke patients

2014 ◽  
Vol 21 (8) ◽  
pp. 1428-1432 ◽  
Author(s):  
Dae-Hyun Kim ◽  
Jae-Kwan Cha ◽  
Hyun-Seok Park ◽  
Jae-Hyung Choi ◽  
Myung-Jin Kang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
Intravenous Thrombolysis ◽  
Direct Access ◽  
Stroke Patients ◽  
Thrombolysis Therapy

Gender and thrombolysis therapy in acute ischemic stroke patients with incidence of obesity

2019 ◽  
Vol 40 (9) ◽  
pp. 1829-1839 ◽  
Author(s):  
Brice Blum ◽  
Alexandria Penwell ◽  
Leah Wormack ◽  
Brittany Walker ◽  
Shyyon Lari ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Thrombolysis Therapy

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

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 &ndash; 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 &ndash;43.529, P=0.019),previous TIA (OR= 0.444, 95% CI, 0.517 &ndash;0.971, P=0.012), and congestive heart failure (OR= 0.217, 95% CI, 0.318 &ndash;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.

scholarly journals Role of Span-75 in Determining Prognosis of Non-Thrombolysis Acute Ischemic Stroke Patients

Medicinus ◽  
2020 ◽  
Vol 7 (7) ◽  
pp. 209
Author(s):  
Anyeliria Sutanto ◽  
Astra Dea Simanungkalit ◽  
Evelyn Yunita ◽  
Anastasya Chandra ◽  
Aristo Pangestu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Degree Of Disability ◽  
Stroke Disability ◽  
And Gender ◽  
Severe Degree ◽  
Time Of Admission ◽  
Thrombolysis Therapy

<div class="WordSection1"><p><strong>Introduction: </strong>The SPAN-75 index is a modification of the SPAN-100 index as a prognostic tool in acute ischemic stroke patients. Previous studies were using SPAN index in cases of ischemic stroke patients treated with rTPA and in cases of intracerebral hemorrhage.</p><p><strong>Aim: </strong>To determine the role of the SPAN-75 index as a prognostic scoring in patients with acute ischemic stroke who did not get thrombolysis therapy.</p><p><strong>Method: </strong>The subjects were acute ischemic stroke patients at Siloam Hospitals Lippo Village who were not treated with thrombolysis therapy and had no disability before stroke onset during January to April 2019. Subjects were classified into a positive and negative of SPAN-75 index group. Disability due to stroke was assessed with Modified Rankin Score (mRS) at the time of admission and discharged from the hospital. This prospective study was analyzed by the Kruskal-Wallis test.</p><p><strong>Result</strong>: Forty subjects (average age of 57 years old) consisted of 31 negative and 9 positive of SPAN-75. Based on the Kruskal-Wallis test, the SPAN-75 index was positively associated with a more severe degree of stroke disability at the time of admission (p = 0.002), but not related to the change in the degree of disability when the patient was discharged from the hospital (p = 0.807). Age (p = 0.445) and gender (p = 0.578) had no significant relationship with the degree of disability of acute ischemic stroke.</p><p><strong>Conclusion: </strong>The SPAN-75 index is related to the degree of disability of acute stroke patients at the time of admission.</p></div>

scholarly journals In acute ischemic stroke patients with smoking incidence, are more women than men more likely to be included or excluded from thrombolysis therapy?

2020 ◽  
Vol 16 ◽  
pp. 174550652092276
Author(s):  
Oluyemi R Rotimi ◽  
Iretioluwa F Ajani ◽  
Alexandria Penwell ◽  
Shyyon Lari ◽  
Brittany Walker ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Initial Examination ◽  
Tissue Plasminogen ◽  
History Of ◽  
Thrombolysis Therapy

Background: Clinical factors associated with exclusion from recombinant tissue plasminogen activator in both men and women are not completely understood. The aim of this study is to determine whether there is a gender difference in clinical risk factors that excluded ischemic stroke patients with a history of smoking from recombinant tissue plasminogen activator. Methods: Retrospective data from a stroke registry were analyzed, and multivariable linear regression models were used to determine gender differences. Logistic regression models determined exclusion clinical risk factors for thrombolysis in male and female acute ischemic stroke patients with a history of smoking, while sequentially adjusting for sociodemographic, clinical, and stroke-related variables. The Kaplan–Meier survival analysis was used to determine the exclusion probabilities of men and women with a history of smoking within the stroke population. Results: Of the 1,446 acute ischemic stroke patients eligible for recombinant tissue plasminogen activator, 379 patients with a history of smoking were examined, of which 181 received recombinant tissue plasminogen activator while 198 were excluded from receiving recombinant tissue plasminogen activator. Of the 198 patients, 75 females and 123 males were excluded from receiving recombinant tissue plasminogen activator. After multivariable adjustment for age, National Institutes of Health scores, and stroke-related factors, females who present with weakness/paresis on initial examination (OR = 0.117, 95% CI, 0.025–0.548) and men who present with a history of previous transient ischemic attack (OR = 0.169, 95% CI, 0.044–0.655), antiplatelet medication use (OR = 0.456, 95% CI, 0.230–0.906), and weakness/paresis on initial examination (OR = 0.171, 95% CI, 0.056–0.521) were less likely to be excluded from recombinant tissue plasminogen activator (thrombolysis therapy). Conclusions: In an ischemic stroke population with a history of smoking, female smokers are more likely to be excluded from thrombolysis therapy in comparison to men, even after adjustment for confounding variables.

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