Abstract W P50: The Influence of Obesity on Outcomes After Intravenous Thrombolysis for Acute Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Syed I Hussain ◽  
Adrienne V Nickles ◽  
Mat J Reeves
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Clinical Outcomes ◽  
Tissue Plasminogen Activator ◽  
Hospital Death ◽  
Obese Patients ◽  
Stroke Patients ◽  
Tissue Plasminogen ◽  
Tract Infections

Background: Current ASA guidelines do not recommend increasing the dose of intravenous tissue plasminogen activator (IV rt-PA) for acute ischemic stroke patients weighing >100 kg. However, the consequences of such potential under-dosing may mean that it is less effective or even less harmful. Objective: To determine the relationship between obesity and clinical outcomes among acute ischemic stroke patients receiving IV rt-PA. Methods: We identified patients who received IV recombinant tissue plasminogen activator (rt-PA) at 35 hospitals participating in the Michigan Coverdell Acute Stroke Registry from January2009 to December 2011. All ischemic strokes treated within 4.5 hours with non-missing BMI data were included in the analysis. Patient BMI was dichotomized as obese (BMI ≥30) or non-obese (BMI <30). Outcome measures included symptomatic intracerebral hemorrhage (sICH), in-hospital death, complications, length of stay (LOS) and discharge to home. The independent effects of obesity on outcomes were analyzed using logistic regression analysis with adjustment for age, gender, race and medical history. Results: Of 698 AIS patients who received IV rt-PA 536 (76.7%) had information on BMI recorded. Among those, 263 (37.7%) were obese. Compared to non-obese patients, obese patients were more likely to be women (57.8% vs. 44.6% p=0.0007), be younger (mean age 64.0 vs. 69.7 p<0.0001), and have hypertension and diabetes mellitus. Obese patients had longer LOS (mean 7.0 vs. 5.8 days, p=0.009) and were more likely to develop urinary tract infections (6.3 % vs. 11.3 %; p=0.009). In a multivariate regression model adjusting for age, gender, race medical comorbidities, obese to non-obese patients rates of sICH (OR, 95% CI 1.2 (0.47- 3.2), p= 0.68, death [OR, 95% CI 1.2 (0.56- 2.8),p=0.60] and discharge to home [OR, 95% CI 1.0 (0.69- 1.5), p=0.89)were all similar. Conclusion: Obese patients receiving IV t-PA treatment for acute ischemic stroke had similar rates of in-hospital mortality, discharge to home and sICH, but they had longer LOS and rates of UTI. Future studies should be undertaken to determine if the clinical efficacy of tPA is affected by under-dosing focusing on both radiographic recanalization rates and functional clinical outcomes.

Abstract T P66: Safety and Effectiveness of Intravenous Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients on Aspirin and Clopidogrel

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Mushtaq H Qureshi ◽  
Shayaan M Khan ◽  
Nauman Jahangir ◽  
Ahmed A Malik ◽  
Melissa Freese ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Combination Therapy ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Favorable Outcome ◽  
Stroke Patients ◽  
Neurological Improvement ◽  
Tissue Plasminogen

Background: The number of acute ischemic stroke patients who are on both aspirin and clopidogrel treatment at time of acute ischemic event is increasing. There is limited data regarding the safety and efficacy of intravenous recombinant tissue plasminogen activator (rt-PA) treatment in such patients. Methods: We reviewed the medical records and imaging data of consecutive patients with acute ischemic stroke who received IV rt-PA within 4.5 hours of symptom onset. We stratified the patients based on active regular use of antiplatelet medications: monotherapy (aspirin or clopidogrel), combination therapy (aspirin and clopidogrel), and no therapy and compared the rates of symptomatic intracerebral hemorrhage (ICH), neurological improvement (≥4 points in National Institutes of Health Stroke Scale [NIHSS], and favorable outcome (modified Rankin scale [mRS] 0-1) at discharge between the three groups. Results: A total of 88 acute ischemic stroke patients (mean age±SD; 69.88 ±15) were treated with IV rt-PA within the study duration. Of the 88 patients 45 (50.6%), 37 (41.6%), and 52 (58.4) were on monotherapy, combination therapy, or no therapy at time of presentation. The proportion of patients who developed symptomatic ICHs were similar (p=0.8) in monotherapy, combination therapy, and no therapy groups (3.3%, 0.0%, and 4.1%, respectively). The rates of neurological improvement were greater in patients on monotherapy (20%) (p=0.03) followed by combination therapy (11.1%), and no therapy groups (2.0%). There was no significant reduction in the rate of favorable outcome at discharge among patients on combination treatment compared with no treatment (odds ratio 0.8 , 95% confidence interval 0.4-1.8 ) after adjusting for age and initial NIHSS score strata (<10, 10-19, and ≥20). Conclusions: Compared with patients on no antiplatelet treatment, acute ischemic stroke patients who are actively using aspirin and clopidogrel appear to have similar risks and benefits with IV rt-PA treatment.

ERic Acute StrokE Recanalization: A study using predictive analytics to assess a new device for mechanical thrombectomy

2017 ◽  
Vol 12 (6) ◽  
pp. 659-666 ◽  
Author(s):  
Susanne Siemonsen ◽  
Nils D Forkert ◽  
Martina Bernhardt ◽  
Götz Thomalla ◽  
Martin Bendszus ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Trial Design ◽  
Mechanical Thrombectomy ◽  
Predictive Analytics ◽  
Stroke Patients ◽  
Tissue Plasminogen

Aim and hypothesis Using a new study design, we investigate whether next-generation mechanical thrombectomy devices improve clinical outcomes in ischemic stroke patients. We hypothesize that this new methodology is superior to intravenous tissue plasminogen activator therapy alone. Methods and design ERic Acute StrokE Recanalization is an investigator-initiated prospective single-arm, multicenter, controlled, open label study to compare the safety and effectiveness of a new recanalization device and distal access catheter in acute ischemic stroke patients with symptoms attributable to acute ischemic stroke and vessel occlusion of the internal cerebral artery or middle cerebral artery. Study outcome The primary effectiveness endpoint is the volume of saved tissue. Volume of saved tissue is defined as difference of the actual infarct volume and the brain volume that is predicted to develop infarction by using an optimized high-level machine learning model that is trained on data from a historical cohort treated with IV tissue plasminogen activator. Sample size estimates Based on own preliminary data, 45 patients fulfilling all inclusion criteria need to complete the study to show an efficacy >38% with a power of 80% and a one-sided alpha error risk of 0.05 (based on a one sample t-test). Discussion ERic Acute StrokE Recanalization is the first prospective study in interventional stroke therapy to use predictive analytics as primary and secondary endpoint. Such trial design cannot replace randomized controlled trials with clinical endpoints. However, ERic Acute StrokE Recanalization could serve as an exemplary trial design for evaluating nonpivotal neurovascular interventions.

Tissue Plasminogen Activator Overdose in Acute Ischemic Stroke Patients Linked to Poorer Functional Outcomes

2014 ◽  
Vol 23 (1) ◽  
pp. 155-159 ◽  
Author(s):  
Demetrios J. Sahlas ◽  
Linda Gould ◽  
Richard H. Swartz ◽  
Naufal Mohammed ◽  
Rhonda McNicoll-Whiteman ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Functional Outcomes ◽  
Stroke Patients ◽  
Tissue Plasminogen
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