Abstract TP198: The Impact of Regular Employments on Hyper-Acute Ischemic Stroke

Background and Purpose: We aimed to investigate the differences in weekly variations of stroke occurrence between hyper-acute ischemic stroke patients with and without regular employments (RE), and the impact of RE on outcome. Methods: Consecutive symptomatic ischemic stroke patients with < 4.5 h from onset to door between October 2012 and May 2018 were enrolled. All the situations of employment on admission were obtained from interviews with the participant or substitute guardians. First, we divided the patients into with and without RE to evaluate the differences in weekly variations of stroke occurrence. Second, we divided the same patients into with and without favorable outcome (mRS score of 0 to 2 at 3 months from the onset) to evaluate the impact of RE on outcome. Results: We screened 1,249 consecutive symptomatic ischemic stroke patients, including 385 patients (292 (76%) male, median age 67 years) with hyper-acute ischemic stroke. Of all, 251 patients (65%) were included in RE group. In the multivariate analysis, patients with RE were more likely to develop strokes on Monday compared to that on Sunday and public holiday (OR 2.841, 95% CI 1.145-7,049, p = 0.024, Figure A). In the multivariate analysis, the factors associated with favorable outcome were low NIHSS score on admission (OR 0.909, 95% CI 0.857-0.964, p = 0.001), not receiving endovascular therapy (OR 0.175 95% CI 0.069-0.444, p <0.001), and having RE (OR 2.506, 95% CI 1.049-5.986, p = 0.039, Figure B). Conclusions: There were dramatic differences in weekly variations of hyper-acute ischemic stroke occurrence between patients with and without RE. Monday seems to be “a black day” for ischemic stroke patients with RE. RE had a positive impact on outcome in hyper-acute ischemic stroke.

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Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽

10.1161/str.48.suppl_1.tp13 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ameer E Hassan ◽

Jeffrey L Saver ◽

Mayank Goyal ◽

David S Liebeskind ◽

Reza Jahan ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Pooled Analysis ◽

Favorable Outcome ◽

Stroke Patients ◽

Nihss Score ◽

Post Procedure ◽

Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

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Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

10.21203/rs.3.rs-20274/v2 ◽

2020 ◽

Author(s):

Sang Hee Ha ◽

Yeon-Jung Kim ◽

Sung Hyuk Heo ◽

Dae-il Chang ◽

Bum joon Kim

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Nihss Score ◽

Factors Associated ◽

Vein Thrombosis ◽

Asian Patients ◽

Stroke Mechanism ◽

Deep Vein ◽

D Dimer

Abstract Background: Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke.Methods: Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (>0.5 mg/dl) in acute ischemic stroke patients.Results: During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR=2.579, 95% CI=1.224–5.432; p=0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR=1.191 95% CI=1.095–1.294; p=0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolic stroke (OR=3.777, 95% CI=1.532–9.313; p=0.004; reference: large artery atherosclerosis), NIHSS score (OR=1.087, 95% CI=1.002–1.179; p=0.001) and thrombolysis (OR=12.360, 95% CI 2.456-62.213; p=0.002) were independently associated with elevated abnormal D-dimer levels.Conclusion: The severity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

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Abstract NS7: Presenting Symptoms and Response to Dysphagia Screen Predict Unfavorable Outcome in Acute Ischemic Stroke Patients Who Do Not Receive IV tPA Due to Mild and Rapidly Improving Stroke Symptoms

Stroke ◽

10.1161/str.46.suppl_1.ns7 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Deborah Camp ◽

Katja Bryant ◽

Susan Zimmermann ◽

Cynthia. Brasher ◽

Kerrin M Connelly ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Time Window ◽

Unfavorable Outcome ◽

Favorable Outcome ◽

Nihss Score ◽

Factors Associated ◽

Presenting Symptoms ◽

Lower Likelihood ◽

Iv Tpa

Background & Purpose: Studies have shown that patients who do not receive IV t-PA due to mild and rapidly improving stroke symptoms (MaRISS) are often not discharged home. The purpose of this study was to identify whether presenting symptoms and response to initial dysphagia screen can predict which patients not treated with IV tPA due to MaRISS have an unfavorable outcome. Methods: Acute ischemic stroke (AIS) patients presenting to hospitals participating in the Georgia Coverdell Acute Stroke Registry and not treated with IV t-PA due to MaRISS alone from January 1, 2009 through December 31, 2013 were included in this analysis. Patients who were unable to ambulate or needed assistance to ambulate prior to admission were excluded. Presenting symptoms and response to dysphagia screen were collected from retrospective chart review at participating hospitals. Multivariable regression analysis was used to identify factors associated with a lower likelihood of favorable outcome, defined as discharge to home. During the study period, < 1% of patients presenting to participating hospitals with MaRISS within the 3 hour time window received IV t-PA. Results: Of 841 AIS patients who did not receive IV-tPA due to MaRISS [median NIHSS 1 (Q1-Q3: 0-3)], 160 (19%) did not have a favorable outcome. Factors associated with lower likelihood of a favorable outcome included increasing NIHSS score (per unit OR 0.89, 95% CI 0.84 to 0.93), weakness as the presenting symptom (OR 0.50, 95% CI 0.30 to 0.84), and a failed dysphagia screen (OR 0.43, 95% CI 0.23 to 0.80). Conclusion: Nearly 1 in 5 AIS patients presenting with MaRISS were not discharged to home. Among AIS patients who present with MaRISS and do not receive IV thrombolytic therapy, baseline characteristics including increasing NIHSS score and weakness as a presenting symptom, and a failed dysphagia screen were all associated with a lower likelihood of discharge to home. Given the low rate of patients presenting during the study period, a prospective randomized trial to evaluate IV t-PA treatment focusing on this subgroup of patients is warranted.

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Abstract WP32: Good Reperfusion Can Rescue Acute Ischemic Stroke Patients Treated With Endovascular Therapy Beyond 6 Hours After Onset.

Stroke ◽

10.1161/str.48.suppl_1.wp32 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

KENTARO SUZUKI ◽

Junya Aoki ◽

Yohei Takayama ◽

Arata Abe ◽

Satoshi Suda ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Onset Time ◽

Favorable Outcome ◽

Modified Rankin Scale ◽

Single Center ◽

Stroke Patients ◽

Tissue Plasminogen ◽

Improve Patient

Objective: Endovascular therapy (EVT) within 6 hours from ischemic stroke onset were recommended by 2015 AHA/ASA guideline. Effectiveness and factors for favorable outcome for EVT beyond 6 hours are unclear. We investigated whether onset to puncture time (O2P) beyond 6 hours is associated with outcome at 3 months and what is the favorable factors in patients treated with EVT beyond 6 hours. Methods: We performed a retrospective, single center analysis of patients with acute ischemic stroke who underwent EVT. The O2P, risk factors, reperfusion success rate and outcome at 3 month were assessed. First, all patients were classified into the two groups with EVT beyond 6 hours or not. Second, we compared any characteristics and favorable outcome between two groups. Finally, we investigated independent factors for favorable outcome in patients treated with EVT beyond 6 hours. Favorable outcome and good reperfusion were defined by modified Rankin scale ≤ 2 and thrombolysis in cerebral infarction (TICI) score ≥ 2B, respectively. Results: Of the 130 EVT cases, 124 cases with known onset time were enrolled (age; 75 [66-83] and 74 (60.5%) men). 98 (79%) were treated with EVT within 6 hours and 26 (21%) patients were beyond 6 hours. Absence of atrial fibrillation (11[42%] vs. 70[71%], p=0.01), high DWI-ASPECTS (9 [7-10] vs. 7 [6-9], p=0.01), no use of intravenous tissue plasminogen (1[4%] vs. 50[51%], p<0.01) and low achievement of good reperfusion (14[54%] vs. 77[79%], p=0.01) were more frequently observed in beyond 6 hours group than within 6 hours group. However, favorable outcome was not different between two groups (beyond 6 hours group ;10(38%) vs. within 6 hours group; 43(44%), p = 0.66). In beyond 6 hours group, good reperfusion (9[90%] vs. 5[31%], p=0.01) and presence of hyperlipidemia (7[70%] vs. 3[19], p=0.02) were associated with favorable outcome. On multivariate analysis, only good reperfusion (OR 45.6, 95%CI 3.7-2271.4, p<0.01) was the independent factor associated with favorable outcome. Conclusions: The frequency of favorable outcome in beyond 6 hours group was not lower than within 6 hours group. Good reperfusion can improve patient outcome in O2P within 6 hours as well as beyond 6 hours.

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CTA collateral score predicts infarct volume and clinical outcome after endovascular therapy for acute ischemic stroke: a retrospective chart review

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011731 ◽

2015 ◽

Vol 8 (6) ◽

pp. 559-562 ◽

Cited By ~ 40

Author(s):

Lucas Elijovich ◽

Nitin Goyal ◽

Shraddha Mainali ◽

Dan Hoit ◽

Adam S Arthur ◽

...

Keyword(s):

Multivariate Analysis ◽

Ischemic Stroke ◽

Clinical Outcome ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Chart Review ◽

Infarct Volume ◽

Retrospective Chart Review ◽

Favorable Outcome ◽

Good Clinical Outcome

BackgroundAcute ischemic stroke (AIS) due to emergent large-vessel occlusion (ELVO) has a poor prognosis.ObjectiveTo examine the hypothesis that a better collateral score on pretreatment CT angiography (CTA) would correlate with a smaller final infarct volume and a more favorable clinical outcome after endovascular therapy (EVT).MethodsA retrospective chart review of the University of Tennessee AIS database from February 2011 to February 2013 was conducted. All patients with CTA-proven LVO treated with EVT were included. Recanalization after EVT was defined by Thrombolysis in Cerebral Infarction (TICI) score ≥2. Favorable outcome was assessed as a modified Rankin Score ≤3.ResultsFifty patients with ELVO were studied. The mean National Institutes of Health Stroke Scale score was 17 (2–27) and 38 of the patients (76%) received intravenous tissue plasminogen activator. The recanalization rate for EVT was 86.6%. Good clinical outcome was achieved in 32% of patients. Univariate predictors of good outcome included good collateral scores (CS) on presenting CTA (p=0.043) and successful recanalization (p=0.02). Multivariate analysis confirmed both good CS (p=0.024) and successful recanalization (p=0.009) as predictors of favorable outcome. Applying results of the multivariate analysis to our cohort we were able to determine the likelihood of good clinical outcome as well as predictors of smaller final infarct volume after successful recanalization.ConclusionsGood CS predict smaller infarct volumes and better clinical outcome in patients recanalized with EVT. These data support the use of this technique in selecting patients for EVT. Poor CS should be considered as an exclusion criterion for EVT as patients with poor CS have poor clinical outcomes despite recanalization.

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Abstract TP161: Low Free Triiodothyronine on Admission Should Be Associated With Post-stroke Infection in Acute Stroke Patients

Stroke ◽

10.1161/str.48.suppl_1.tp161 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Satoshi Suda ◽

Takashi Shimoyama ◽

Yohei Takayama ◽

Takahiro Ouchi ◽

Masafumi Arakawa ◽

...

Keyword(s):

Logistic Regression ◽

Regression Analysis ◽

Ischemic Stroke ◽

Thyroid Hormone ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Free Triiodothyronine ◽

Nihss Score ◽

The Impact

Background and purpose: Post-stroke infection (PSI) is a common and it is associated with a severe prognosis. Recent studies have shown that thyroid hormones play critical roles in the immune system regulation. However, association between PSI and thyroid hormone have not been fully elucidated. We therefore investigated the impact of thyroid hormone on PSI in acute stroke patients. Methods: We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 male, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were evaluated upon admission. PSI was defined as infection occurring during hospitalization. The impact of the thyroid hormone on PSI was evaluated using multiple logistic regression analysis. Separate analyses were conducted according to PSI and quartile serum FT3 concentration. Results: PSI was diagnosed in 107 patients (20.6 %). The most common infection was pneumonia with the prevalence of 65 patients (60.7 %), followed by urinary tract infection recorded in 19 patients (17.8 %). Age ( P < 0.001), body mass index ( P = 0.0044), pre-admission mRS ( P = 0.002), NIHSS score on admission ( P < 0.001), admission FT3 (2.63 ± 0.49 pg/mL vs. 2.24 ± 0.66 pg/mL, P < 0.001), and cardio-embolic stroke ( P < 0.001) were significantly associated with PSI, but no relationship between TSH (2.84 ± 8.12 mIU/L vs. 2.20 ± 1.45 mIU/L, P = 0.4610), FT4 (1.22 ± 0.21 ng/dL vs. 1.21 ± 0.28 ng/dL, P = 0.1478), and PSI were found. On multivariable logistic regression analysis, low FT3 (< 2.29 pg/mL; odds ratio [OR], 2.96; 95% confidence interval [CI], 1.61- 5.45; P = 0.0005) and high admission NIHSS score (≥ 9 points, OR, 7.65; 95% CI, 4.10-14.73; P <0.0001) were independently associated with PSI. In comparisons between PSI and FT3 quartiles (Q1 [≤ 2.25 pg/mL], Q2 [2.26-2.55 pg/mL], Q3 [2.56-2.89 pg/mL], Q4 [≥ 2.90 pg/mL]), patients with PSI were significantly more frequent in Q1 than in Q2, Q3, and Q4 after multivariate adjustment. Conclusions: Our results showed that a low FT3 at admission should be associated with PSI in acute ischemic stroke patients.

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Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke

10.21203/rs.3.rs-20274/v1 ◽

2020 ◽

Author(s):

Sang Hee Ha ◽

Yeon-Jung Kim ◽

Sung Hyuk Heo ◽

Dae-il Chang ◽

Bum Joon Kim

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Patients ◽

Nihss Score ◽

Factors Associated ◽

Vein Thrombosis ◽

Asian Patients ◽

Stroke Mechanism ◽

Deep Vein ◽

D Dimer

Abstract Background: Deep vein thrombosis (DVT) is an important complication of ischemic stroke, although the incidence of DVT is regarded as being lower in Asian than in non-Asian patients. Here, we investigated the incidence and factors associated with DVT in Asian patients with ischemic stroke. Methods: Acute ischemic stroke patients received lower extremity ultrasonography (LEUS) to diagnose the presence of DVT. Clinical characteristics and laboratory results, including D-dimer level, were compared between patients with and without DVT. Independent risk factors for DVT were investigated using multivariable analysis. Similar analysis was performed to identify factors associated with elevated D-dimer level (>0.5 mg/dl was regarded as abnormal) in acute ischemic stroke patients. Results: During the study period, 289 patients were enrolled, and 38 (13.1%) showed DVT. Female sex (OR=2.579, 95% CI=1.224–5.432; p=0.013) and a high National Institutes of Health Stroke Scale (NIHSS) score (OR=1.191 95% CI=1.095–1.294; p=0.005) were independently associated with the presence of DVT, although D-dimer level was not. Stroke mechanism, especially cardioembolism (OR=3.440 95% CI=1.051–4.078; p=0.006; reference: large artery atherosclerosis), and high NIHSS score (OR=1.135, 95% CI 1.051–1.224; p=0.001) were independently associated with elevated abnormal D-dimer level. Conclusion: The s everity of ischemic stroke, but not the D-dimer level, was associated with the presence of DVT in Asian ischemic stroke patients. D-dimer level was influenced by the stroke mechanism. Performing LEUS in patients with severe neurological deficit, rather than screening with D-dimer, may be more beneficial for diagnosing DVT in Asian patients with acute ischemic stroke.

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Impact of Post-Stroke Recanalization on General and Upper Limb Functioning: A Prospective, Observational Study

Neurology International ◽

10.3390/neurolint13010005 ◽

2021 ◽

Vol 13 (1) ◽

pp. 46-58

Author(s):

João Paulo Branco ◽

Filipa Rocha ◽

João Sargento-Freitas ◽

Gustavo C. Santo ◽

António Freire ◽

...

Keyword(s):

Ischemic Stroke ◽

Observational Study ◽

Acute Ischemic Stroke ◽

Upper Limb ◽

Functional Recovery ◽

Prospective Observational Study ◽

Positive Impact ◽

Rehabilitation Program ◽

Patient Functioning ◽

The Impact

The objective of this study is to assess the impact of recanalization (spontaneous and therapeutic) on upper limb functioning and general patient functioning after stroke. This is a prospective, observational study of patients hospitalized due to acute ischemic stroke in the territory of the middle cerebral artery (n = 98). Patients completed a comprehensive rehabilitation program and were followed-up for 24 weeks. The impact of recanalization on patient functioning was evaluated using the modified Rankin Scale (mRS) and Stroke Upper Limb Capacity Scale (SULCS). General and upper limb functioning improved markedly in the first three weeks after stroke. Age, gender, and National Institutes of Health Stroke Scale (NIHSS) score at admission were associated with general and upper limb functioning at 12 weeks. Successful recanalization was associated with better functioning. Among patients who underwent therapeutic recanalization, NIHSS scores ≥16.5 indicate lower general functioning at 12 weeks (sensibility = 72.4%; specificity = 78.6%) and NIHSS scores ≥13.5 indicate no hand functioning at 12 weeks (sensibility = 83.8%; specificity = 76.5%). Recanalization, either spontaneous or therapeutic, has a positive impact on patient functioning after acute ischemic stroke. Functional recovery occurs mostly within the first 12 weeks after stroke, with greater functional gains among patients with successful recanalization. Higher NIHSS scores at admission are associated with worse functional recovery.

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Abstract P119: Factors Influencing Door to Needle Administration for Acute Stroke Patients in the Emergency Department

Stroke ◽

10.1161/str.52.suppl_1.p119 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nicolle W Davis ◽

Meghan Bailey ◽

Natalie Buchwald ◽

Amreen Farooqui ◽

Anna Khanna

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Patient Outcomes ◽

Time Of Day ◽

Stroke Patients ◽

Acute Stroke Care ◽

The Impact ◽

Iv Tpa

Background/Objective: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention remains essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous thrombolytic (IV tPa). The objective of this pilot is to evaluate factors of acute stroke care in the emergency department (ED) and the impact they have on IV tPa administration. Methods: A sample of 89 acute ischemic stroke patients that received IV tPa from a single academic medical institution was selected for retrospective analysis. System characteristics (presence of a stroke nurse and time of day) and patient characteristics (mode of arrival and National Institutes of Health Stroke Scale score (NIHSS) on arrival) were analyzed using descriptive statistics and multiple regression to address the study question. Results: The mean door to needle time is 53.74 minutes ( + 38.06) with 74.2% of patients arriving to the ED via emergency medical services (EMS) and 25.8% having a stroke nurse present during IV tPa administration. Mode of arrival ( p = .001) and having a stroke nurse present ( p = .022) are significant predictors of door to needle time in the emergency department (ED). Conclusion: While many factors can influence door to needle times in the ED, we did not find NIHSS on arrival or time of day to be significant factors. Patients arriving to the ED by personal vehicle will have a significant delay in IV tPa administration, therefore emphasizing the importance of using EMS. Perhaps more importantly, collaborative efforts including the addition of a specialized stroke nurse significantly decreased time to IV tPa administration for AIS patients. With this dedicated role, accelerated triage and more effective management of AIS patients is accomplished, leading to decreased intervention times and potentially improving patient outcomes.

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Abstract 1122‐000214: Clinical Factors Associated rTPA Administration in Acute Ischemic Stroke Patients with History of Atrial Fibrillation

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000214 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Chase A Rathfoot ◽

Camron Edressi ◽

Carolyn B Sanders ◽

Krista Knisely ◽

Nicolas Poupore ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Medical History ◽

Clinical Decision Making ◽

Past Medical History ◽

Clinical Factors ◽

Stroke Patients ◽

Factors Associated ◽

History Of

Introduction : Previous research into the administration of rTPA therapy in acute ischemic stroke patients has largely focused on the general population, however the comorbid clinical factors held by stroke patients are important factors in clinical decision making. One such comorbid condition is Atrial Fibrillation. The purpose of this study is to determine the clinical factors associated with the administration of rtPA in Acute Ischemic Stroke (AIS) patients specifically with a past medical history of Atrial Fibrillation (AFib). Methods : The data for this analysis was collected at a regional stroke center from January 2010 to June 2016 in Greenville, SC. It was then analyzed retrospectively using a multivariate logistic regression to identify factors significantly associated with the inclusion or exclusion receiving rtPA therapy in the AIS/AFib patient population. This inclusion or exclusion is presented as an Odds Ratio and all data was analyzed using IBM SPSS. Results : A total of 158 patients with Atrial Fibrillation who had Acute Ischemic Strokes were identified. For the 158 patients, the clinical factors associated with receiving rtPA therapy were a Previous TIA event (OR = 12.155, 95% CI, 1.125‐131.294, P < 0.040), the administration of Antihypertensive medication before admission (OR = 7.157, 95% CI, 1.071‐47.837, P < 0.042), the administration of Diabetic medication before admission (OR = 13.058, 95% CI, 2.004‐85.105, P < 0.007), and serum LDL level (OR = 1.023, 95% CI, 1.004‐1.042, P < 0.16). Factors associated with not receiving rtPA therapy included a past medical history of Depression (OR = 0.012, 95% CI, 0.000‐0.401, P < 0.013) or Obesity (OR = 0.131, 95% CI, 0.034‐0.507, P < 0.003), Direct Admission to the Neurology Floor (OR = 0.179, 95% CI, 0.050‐0.639, P < 0.008), serum Lipid level (OR = 0.544, 95% CI, 0.381‐0.984, P < 0.044), and Diastolic Blood Pressure (OR = 0.896, 95% CI, 0.848‐0.946, P < 0.001). Conclusions : The results of this study demonstrate that there are significant associations between several clinical risk factors, patient lab values, and hospital admission factors in the administration of rTPA therapy to AIS patients with a past medical history of Atrial Fibrillation. Further research is recommended to determine the extent and reasoning behind of these associations as well as their impact on the clinical course for AIS/AFib patients.

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