Abstract WP447: Early Mobilization After 12 Hours Post-Thrombolysis is Safe and Reduces Length of Stay in Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Laurel Packard ◽  
Tricia Tubergen ◽  
Hattie LaCroix ◽  
Danielle Gritters ◽  
Nicholas Ames ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Bed Rest ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Patients ◽  
Discharge Disposition ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Significant Difference

Background: Bed rest of 24 hours post-thrombolysis is recommended for acute ischemic stroke patients. We sought to compare outcomes and in-hospital complications of 12- and 24-hour bed rest protocols following thrombolysis in minor stroke patients. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke that received tPA only and who had an initial National Institute of Health Stroke Scale (NIHSS) 0-5 between 1/1/2017 and 3/30/2019 were included. Stroke mimics and patients who underwent mechanical thrombectomy were excluded. The standard practice bed rest order for the 24 hour protocol prior to 07/15/2017 was compared with the 12 hour bed rest order protocol after that date. The primary outcome was length of stay. Secondary outcome measures included symptomatic intracerebral hemorrhage (sICH), deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days and modified rankin scale (mRS) at 90 days. Results: Of the 106 patients identified, 36 patients were in the 24-hour protocol and 70 were in the 12-hour bed rest protocol group. There was significant difference for length of stay in the 24-hour bed rest protocol (2.9 days) compared with the 12-hour bed rest protocol (2.0 days) (p=0.032). Compared with the 24-hour bed rest group, the rates of sICH (p=NS), DVT (p=NS), PE (p=NS), pneumonia (p=NS), favorable discharge disposition (p=NS), 30 day readmission (p=0.NS) and 90 day mRS 0-2 (p=NS) were not different between the groups. Time to mobilization was significantly different between the two groups (24 hour group:2043.2 ± 680.1 minutes; 12 hour group:1221.0 ± 527.8) (p<0.0001). Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with significantly earlier patient mobilization and reduced length of stay without any adverse outcomes. A randomized trial is needed to verify these findings.

Abstract 3730: Length Of Hospitalization And Discharge Disposition Among Acute Ischemic Stroke Patients With Moderate To Severe Stroke by Treatment

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Steven A Koehler ◽  
Maxim Hammer ◽  
Vivek Reddy ◽  
Houhammad Jumaa ◽  
Syed Zaidi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Treatment Modality ◽  
Cerebral Arteries ◽  
Stroke Patients ◽  
Term Care ◽  
Severe Stroke ◽  
Discharge Disposition ◽  
Significant Difference

Background: Data regarding length of stay and discharge disposition in patients with moderate to severe stroke are scarce. We sought to determine Length of Stay (LoS) in a consecutive group of patients admitted at a large academic center and assess for any possible difference in LoS at discharge by treatment modality received and by vessels occlusion status. Methods: Retrospective review of a database comprising acute ischemic stroke patients admitted to our center between 1/1/2009-3/31/2011. Patient Demographics, treatment modality (IV thrombolytic tissue plasminogen activator (IVtPA), Endovascular (IA), no thrombolytic (NT), LoS, occlusion of major cerebral arteries and discharge disposition were collected. Inclusion criteria were AIS with admission NIHSS ≥10. Results: A total of 744 patients 361 (48.5%) male, mean age 69.9 years were identified. Treatment modalities: 174 (23%) IVtPA, 177 (24%) IA, 393 (53%) NT. Median NIHSS 16.5 and not significant among the 3 groups (P=.603). Mean LoS was 7.38 days (SD 7.4) with no significant difference between the 3 groups (P=.056). Occlusion to one of the 3 cerebral arteries (ICA, MCA, BA) was: 84% in IVtPA, 100% in IA, 87% in NT. Discharge disposition and LoS by treatment and occlusions are shown in the Table . Among patients treated with IVtPA (n=174) mean LoS was 6.33 days (range 1-27). LoS was significantly longer among those without occlusion vs with any occlusion (P=.001). Among patients that received IA (n=177) mean LoS was 8.21 days (range 0-74). Among patients received NT (n=393) the mean LoS was 7.47 days (range 0-64). Conclusions: Thrombolytic therapy (IV or EV) in patients with strokes is not associated with longer hospitalizations duration. A significant difference between death rates in patients receiving IA thrombolytic (22%) compared to IV (32%) or NT (30%) was found with fewer death among those that received IA (P= .008). Patients discharged to long term care facilities have regardless of treatment longer LoS (12.41v 6.14) (P>.000).

Abstract WP448: Shorter Intensive Care Unit Stay (12 Hours) Post Thrombolysis is Safe and Reduces Length of Stay for Minor Stroke Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Tricia Tubergen ◽  
Laurel Packard ◽  
Danielle Gritters ◽  
Hattie LaCroix ◽  
Andrea Goosen ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Bed Rest ◽  
Tissue Type ◽  
Minor Stroke ◽  
Secondary Outcome ◽  
Stroke Patients ◽  
Icu Stay

Background and Purpose: Acute Stroke Patients treated with intravenous tissue-type plasminogen activator (tPA) require intensive care unit (ICU) monitoring for 24 hours post-treatment due to risk of symptomatic intracranial hemorrhage (sICH). This is a costly and resource intensive practice. In this study, we evaluated the safety and efficacy of shorter ICU monitoring for minor stroke patients treated with tPA. Methods: Consecutive patients age >18 years with a diagnosis of ischemic stroke that received tPA only and who had an initial National Institute of Health Stroke Scale (NIHSS) 0-5 between 1/1/2017 and 3/30/2019 were included. Stroke mimics and those who underwent thrombectomy were excluded. Standard practice 24 hour ICU stay prior to 05/15/2018 was compared with 12 hour ICU stay after that date. The primary outcome was length of stay. Secondary outcome measures included sICH, deep venous thrombosis (DVT), pulmonary embolism (PE), pneumonia, favorable discharge to home or acute rehabilitation, readmission within 30 days, and modified rankin scale (mRS) at 90 days. Results: Of the 122 patients identified, 77 patients were in the 24-hour protocol and 45 were in 12-hour ICU stay protocol groups. There was significant difference in length of stay for the 24-hour ICU stay protocol (2.8 days) compared with the 12-hour ICU stay protocol (1.8 days) ( P <.001). Compared with the 24-hour ICU stay, the rates of sICH ( p = .65), DVT ( p = NS), PE ( p = NS), pneumonia ( p = 1.00), favorable discharge disposition ( p = .26), 30 day readmission ( p =0.06) and 90 day mRS 0-2 ( p = .37) were not different between the groups. Conclusion: Compared with 24-hour bed rest, 12-hour bed rest after thrombolysis for minor acute ischemic stroke was associated with without any adverse outcomes. A randomized trial is needed to verify these findings.

Abstract T P308: Does Hospitalist Directed Care Reduce The Length Of Stay For Acute Ischemic Stroke Patients And Improve Adherence To The “Get With The Guidelines” Inpatient Quality Measures?

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Christian Sanchez ◽  
Ahmed A Malik ◽  
Erlinda Abantao ◽  
Olive Sanchez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Family Practice ◽  
Quality Measures ◽  
Stroke Patients ◽  
Thromboembolism Prophylaxis ◽  
Acute Ischemic Stroke Patient ◽  
Significant Difference ◽  
Get With The Guidelines

Background: Hospitalist directed care has shown significant association with improved lengths of stay with improvements in outcomes in several acute conditions. The hospitalist effect has not been studied in acute ischemic stroke management. Objective: To identify acute ischemic stroke patients admitted under a hospitalist, internist, family practice physician, or a specialist and compare the length of stay, discharge outcome, and adherence to the “Get with the Guidelines” (GWTG) stroke performance measures prior to discharge. Methods: We identified consecutive acute ischemic stroke patients over a 4-year period (June 2010-June 2014) from a private Gold Plus Target Stroke Honor Roll primary stroke center. We categorized all stroke admissions according to admitting physicians - hospitalist, internist, family practice, or specialty physician directed care. We collected demographics, risk factors and discharge outcomes based on the modified Rankin Scale (mRS). We analyzed all of the GWTG stroke inpatient quality measures (venous thromboembolism prophylaxis, statin on discharge, anthithrombotic by end of day 2, antithrombotic medication on discharge, atrial fibrillation discharged on anticoagulant) and compared rate of deficiencies between the four groups of admitting physicians. Results: A total of 1584 patients [mean age (± SD) 68.6±13.7 years; 55.6% men] were admitted with acute ischemic stroke. There was no statistically significant difference in length of stay between the 4 groups (p=0.4). There was a significant difference in the GTWG inpatient quality measures with the hospitalist group having the lowest rates of deficiencies seen with 5% of their admissions (p=0.03), and the internists have the highest rate of deficiencies with 16% of their admissions (p=0.01). The most common deficiency was not prescribing a statin at discharge (56% of total fallouts). There was no difference in poor outcomes on discharge (mRS 3-6) (p=0.2). Conclusions: There is a significant improvement in adherence to the GWTG inpatient stroke measures when an acute ischemic stroke patient is admitted under the care of a hospitalist. Prospective databases are recommended to evaluate if this leads to better long term outcomes.

Abstract TP16: Short-Term Thrombectomy Outcomes Beyond the Traditional 6-Hour Time Window: Analysis of a Multi-Hub Telestroke Network

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Archit Bhatt ◽  
Lindsay Lucas ◽  
Elizabeth Baraban
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracranial Hemorrhage ◽  
Time Window ◽  
Stroke Patients ◽  
Short Term ◽  
Real World Data ◽  
Term Outcome ◽  
Discharge Disposition ◽  
Significant Difference

Background/Purpose: Acute ischemic stroke patients with large vessel occlusions are traditionally treated with thrombectomy within a 6-hour time window. Often patients get groin punctures for thrombectomy beyond 6 hours. The purpose of our study is to report real world data comparing short-term outcome differences in patients who receive groin punctures within 6 hours versus beyond 6 hours in a multi-hub telestroke network. Method: Data obtained from the Providence Health and Services Get With the Guidelines stroke registry were used to identify AIS patients who received intra-arterial (IA) intervention and were discharged from the hospital between November 2014 and May 2016. Patients were categorized as having Last Known Well-to-Groin-Puncture times (LKW-to-GP) over six hours or LKW-to-GP below or equal to six hours. Outcomes were modified rankin score (mRS) at discharge (slight or no disability versus moderate disability to dead), discharge disposition (home versus not home), change in NIHSS from admittance to discharge, and length of stay (LOS). Multivariate analyses were used to determine impact of the LKW-to-GP group on outcomes adjusting for post thrombolysis in cerebral infarction (TICI) grade, pre-symptom onset mRS, and admission NIHSS score. Intracranial hemorrhage rates were compared between the two groups using Fisher’s exact test. Results: We identified 136 ischemic stroke patients, 46.3% female with a mean age of 70.7 years (±14.6), who received IA intervention and were discharged between November 2014 and May 2016. Of those, 21% (n=29) had LKW-to-GP below or equal to six hours and 79% (n=107) had LKW-to-GP above six hours. After adjusting for covariates, there were no statistically significant differences in discharge mRS (p=.284), discharge disposition (p=.736), length of stay (p=.473) and change in NIHSS (p=.135). Unadjusted intracranial hemorrhage rates (p=.101) between the two LKW-to-GP groups were also not significant. Conclusions: We discovered one in five patients were treated beyond the traditional time window in a multi-hub telestroke network. We found no statistically significant difference in short term outcomes in patients receiving thrombectomy beyond 6 hours compared to those receiving thrombectomy within 6 hours.

Abstract P13: Faster Treatment Speed is Not Associated With Bleeds: Intravenous Alteplase Treatment in the Ultra-Early Time Window is Safe

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Michelle Provencher ◽  
Ashley Scherman ◽  
Elizabeth Baraban ◽  
Robert Jackson ◽  
Tamela L Stuchiner ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Statistical Significance ◽  
Hospital Length Of Stay ◽  
Bleeding Complications ◽  
Stroke Patients ◽  
Related Complication ◽  
Discharge Disposition ◽  
Significant Difference

Previous studies have shown that faster Door to Needle (DTN) treatment times are associated with better outcomes for acute ischemic stroke patients. With the continued push for faster times, we aimed to determine if DTN treatment times in the 30- vs 45-minute time window yielded statistically significant differences in outcomes or complications. Data obtained from a multi-state stroke registry included acute ischemic stroke patients ≥18 years of age discharged between January 2017 and April 2020, and treated with IV alteplase with DTN times between 25-30 or 40-45 minutes. Outcomes were 90-day Modified Rankin Score (mRS) (0-2 vs 3-6), discharge disposition [home or inpatient rehabilitation facility (IRF) vs other location], complications (any treatment-related complication vs none), and hospital length of stay (LOS). Patients with a documented reason for delay or who received thrombectomy were excluded. Outcomes of patients with 25- to 30-minute DTN times were compared to those with 40- to 45-minute DTN times using generalized linear models and multiple linear regression, adjusting for admission NIHSS, age, gender, race/ethnicity, and medical history. Compared to the 20-25 minute group, patients treated in the 40-45 minute window had higher odds of a documented 90-day mRS of 3 or more (Adjusted Odds Ratio (AOR)=1.19, p=0.253, n=201 ) and treatment-related complication (AOR=1.35, p=0.569) and lower odds of discharge to home or IRF (AOR=0.846, p=0.359). There was little difference in LOS (β=-0.008, p=0.847). None of the outcomes reached statistical significance. Administering alteplase in the 25- to 30-minute window is safe and did not result in an increase in bleeding complications. Although faster treatment times trended toward better outcomes, there was no statistically significant difference between the 25-30 and 40-45 minute DTN treatment times.

Abstract WP9: Primary Aspiration Thrombectomy in Acute Ischemic Stroke: A Single-Center Experience

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Ganesh Asaithambi ◽  
Amy L Castle ◽  
Lana J Stein ◽  
Sandra K Hanson ◽  
Jeffrey P Lassig
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Stroke Severity ◽  
Single Center ◽  
Aspiration Thrombectomy ◽  
Discharge Disposition ◽  
Single Center Experience ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stent Retrievers

Background: Recent endovascular stroke studies utilizing primarily stent retrievers have proven clinical benefit among eligible patients. It remains unclear if this benefit is exclusive to stent retrievers. We present the results of a single-center experience for patients undergoing primary aspiration thrombectomy for acute ischemic stroke (AIS). Methods: A retrospective analysis of all AIS patients receiving primary aspiration thrombectomy from January 2014 to March 2016 was performed. We assessed stroke severity at admission and discharge as defined by the National Institutes of Health Stroke Scale score (NIHSSS), median onset to puncture and onset to recanalization times, location of target vessel treated, rate of concurrent intravenous (IV) alteplase use, and rate of TICI 2b/3 reperfusion. Outcomes adjudicated included rates of symptomatic intracerebral hemorrhage (sICH), favorable discharge disposition to home, and 90-day modified Rankin Scale (mRS) score ≤2. Results: During the study period, 121 patients (mean age 68.7±16.5 years, 53.7% women) received primary aspiration thrombectomy for 124 occlusions (26% terminal internal carotid artery, 45% M1, 15% M2, 11% basilar artery, 3% other). Median admission NIHSSS was 19 [11, 22] and improved to 6 [1, 15] upon discharge. Median onset to puncture and onset to recanalization times were 258 [148, 371] and 300 [180, 409] minutes, respectively. The rate of TICI 2b/3 reperfusion was 84.7%, and 52% received adjunctive IV alteplase. Rates of favorable discharge to home was 28.9% and 90-day mRS ≤2 was 39.8%. Only one patient developed sICH. Conclusion: Our single-center experience shows that primary aspiration thrombectomy can yield both favorable angiographic and clinical outcomes with minimal adverse effect.

Acute intracranial stenting with mechanical thrombectomy is safe and efficacious in patients diagnosed with underlying intracranial atherosclerotic disease

2021 ◽  
pp. 159101992110394
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen G Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Cerebral Infarction ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Intracranial Stenting ◽  
Intracranial Atherosclerotic Disease

Objective To investigate whether significant differences exist in recanalization rates and primary outcomes between patients who undergo mechanical thrombectomy alone versus those who undergo mechanical thrombectomy with acute intracranial stenting. Methods Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2020, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage, mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score and modified Rankin Scale were examined. The outcomes between patients receiving acute intracranial stenting + mechanical thrombectomy and patients that underwent mechanical thrombectomy alone were compared. Results There were a total of 420 acute ischemic stroke patients who met criteria for the study (average age 70.6 ± 13.01 years; 46.9% were women). Analysis of 46 patients from the acute stenting + mechanical thrombectomy group (average age 70.34 ± 13.75 years; 37.0% were women), and 374 patients from the mechanical thrombectomy alone group (average age 70.64 ± 12.92 years; 48.1% were women). Four patients (8.7%) in the acute stenting + mechanical thrombectomy group experienced intracerebral hemorrhage versus 45 patients (12.0%) in the mechanical thrombectomy alone group ( p = 0.506); no significant increases were noted in the median length of stay (7 vs 8 days; p = 0.208), rates of modified thrombolysis in cerebral infarction 2B-3 recanalization ( p = 0.758), or good modified Rankin Scale scores ( p = 0.806). Conclusion Acute intracranial stenting in addition to mechanical thrombectomy was not associated with an increase in overall length of stay, intracerebral hemorrhage rates, or any change in discharge modified Rankin Scale. Further research is required to determine whether mechanical thrombectomy and acute intracranial stenting in acute ischemic stroke patients is unsafe.

scholarly journals HUBUNGAN PERDARAHAN GASTROINTESTINAL DENGAN LUARAN PASIEN STROKE ISKEMIK AKUT

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Rico Defryantho ◽  
Lisda Amalia ◽  
Ahmad Rizal ◽  
Suryani Gunadharma ◽  
Siti Aminah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Gastrointestinal Bleeding ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Exclusion Criteria ◽  
Risk Of Death ◽  
History Of ◽  
Gcs Score

     ASSOCIATION BETWEEN GASTROINTESTINAL BLEEDING WITH CLINICAL OUTCOME ACUTE ISCHEMIC STROKE PATIENTABSTRACTIntroduction: Gastrointestinal bleeding associated by the delay in the administration of antiplatelet and anticoagulant, thus affected the clinical outcome and patient treatment.Aims: To find the association between gastrointestinal bleeding and clinical outcome in acute ischemic stroke patient.Methods: This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung in November 2017 to February 2018. Acute ischemic stroke patients that fulfill the inclusion and exclusion criteria were observed while being treated in the ward and the survival rate and length of stay were studied. This study used univariate, bivariate, multivariate, and stratification analysis.Results: In the study period, 100 acute ischemic stroke patients were found and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found in patient with gastrointestinal bleeding (20.8%). Median NIHSS score was higher (16 vs 7) and GCS score was lower (12 vs 15) in patients with bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival and length of stay. The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7  vs  22.5 times and 1.5 vs 2 times).Discussion: Ischemic stroke with gastrointestinal bleeding had higher mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.Keyword: Acute ischemic stroke, gastrointestinal bleeding, length of stay, mortalityABSTRAKPendahuluan: Perdarahan gastrointestinal berhubungan dengan penundaan terapi antiplatelet atau antikoagulan, sehingga berpengaruh terhadap luaran dan tata laksana pasien.Tujuan: Mengetahui hubungan perdarahan gastrointestinal dengan luaran pasien stroke iskemik akut.Metode: Penelitian prospektif observasional terhadap pasien stroke iskemik akut di RSUP Dr. Hasan Sadikin, Bandung pada bulan November 2017 hingga Februari 2018. Pasien stroke iskemik akut yang memenuhi kriteria inklusi dan eksklusi diobservasi selama perawatan untuk mengetahui survival dan lama perawatan di rumah sakit. Analisis statistik yang digunakan adalah univariat, bivariat, multivariat, dan stratifikasi.Hasil: Selama periode penelitian didapatkan 100 subjek stroke iskemik akut dengan 24 subjek mengalami perdarahan gastrointestinal. Riwayat ulkus peptikum/perdarahan gastrointestinal sebelumnya sebanyak 20,8% pada perdarahan gastrointestinal. Median skor NIHSS lebih tinggi (16 vs 7) dan skor GCS lebih rendah (12 vs 15) pada perdarahan. Analisis multivariat didapatkan perdarahan gastrointestinal memiliki hubungan signifikan dengan survival dan lama perawatan. Berdasarkan analisis stratifikasi subjek dengan infeksi yang kemudian mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih rendah dibandingkan subjek tanpa infeksi kemudian mengalami perdarahan gastrointestinal (1,7 vs 22,5 kali dan 1,5 vs 2 kali).Diskusi: Stroke iskemik akut yang mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih tinggi dibandingkan tanpa perdarahan gastrointestinal.Kata kunci: Lama perawatan, mortalitas, perdarahan gastrointestinal, stroke iskemik akut

scholarly journals Triglyceride glucose index influences platelet reactivity in acute ischemic stroke patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yinping Guo ◽  
Jing Zhao ◽  
Yi Zhang ◽  
Lingshan Wu ◽  
Zhiyuan Yu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Platelet Reactivity ◽  
Multivariate Logistic Regression Analysis ◽  
Platelet Inhibition ◽  
Inhibition Rate ◽  
Stroke Patients ◽  
Tyg Index ◽  
Significant Difference

Abstract Aim Insulin resistance was reported to increase the risk of ischemic stroke, which can be assessed by the triglyceride glucose (TyG) index. However, it remains unclear whether the TyG index influences the platelet reactivity during the treatment of ischemic patients. Methods Ischemic stroke patients receiving dual antiplatelet therapy (DAPT) within 48 h onset were consecutively included. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The top quartile of TyG index was defined as insulin resistance. The platelet reactivity was assessed by thromboelastography. The platelet inhibition rate induced by arachidonic acid (AA) or adenosine diphosphate (ADP) was used to confirm the high residual on-treatment platelet reactivity (HRPR) to aspirin or clopidogrel, respectively. The association between TyG index and platelet reactivity was assessed by Kruskal–Wallis test. The independent risk factors of HRPR were determined by multivariate logistic regression analysis. Results A total of 1002 patients were included and divided into 4 groups by quartiles of the TyG index (< 2.02; 2.02–2.27; 2.27–2.52; ≥2.52). The findings demonstrated that the maximum intensity of the clot increased, but the AA-induced platelet inhibition rate decreased, depending on the TyG index quartiles. No significant difference was found in the ADP-induced platelet inhibition rate among groups. The prevalence of aspirin HRPR increased depending on the TyG index quartile. Unlike the non-insulin resistance group, the insulin resistance group was independently associated with aspirin HRPR (OR = 1.689, 95% CI 1.14 to 2.51, P = 0.009). Conclusions In acute ischemic stroke patients taking DAPT, the elevation of the TyG index is associated with enhanced platelet reactivity and higher prevalence of aspirin HRPR. Insulin resistance assessed by the TyG index could be an independent risk factor for aspirin HRPR.

Abstract P201: Octogenarian and Nonagenarian Outcomes Among Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
RAJAN R GADHIA ◽  
Farhaan S Vahidy ◽  
Tariq Nisar ◽  
Destiny Hooper ◽  
David Chiu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Combined Treatment ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Intravenous Tissue Plasminogen Activator ◽  
Significant Difference ◽  
Acute Stroke Treatment ◽  
Iv Tpa

Objective: Most acute stroke treatment trials exclude patients above the age of 80. Given the clear benefit of revascularization with intravenous tissue plasminogen activator (IV tPA) and mechanical thrombectomy (MT), we sought to assess functional outcomes in patients treated above the age of 80. Methods: We conducted a review of all patients admitted to Houston Methodist Hospital between January 2019 and August 2020 with an acute ischemic stroke (AIS) presentation[MOU1] for whom premorbid, discharge, and 90 day modified Rankin Scale scores were available. Patients were categorized by acute stroke treatment (IV tPA, MT, both or none[MOU2] ). mRS values were assessed during admission prior to discharge and at 90 days post stroke event. A delta mRS (Discharge vs. 90-day [MOU3] ) was defined and grouped as no change, improved, or worsened to assess overall functional disability in regards to the index stroke presentation. Results: A total of 865 patients with AIS presentation were included, of whom 651 (75.3%) were <80 years and 214 (24.7%) were > 80 years of age at presentation. A total of 208 patients received IV tPA, 176 underwent revascularization with MT only, 71 had both treatments, and 552 had no acute intervention. In patients >80 yrs who had no acute stroke intervention. mRS improvement was noted in 71.4% compared to 54.1% observed in those patients <80 years. Among patients who received IV tPA, 81.5% of > 80 years improved vs. 61.6% in the younger cohort. A similar trend was noted in the MT and combined treatment groups (76.2% vs. 71.2% and 78.6% vs. 79.3%, respectively). Conclusion: Based on our cohort of acute stroke patients, there was no significant difference in outcomes (as measured by delta mRS) for octogenarians and nonagenarians when compared to younger patients. There was a trend towards improvement in the elderly patients. Chronological age by itself may be an insufficient predictor of functional outcome among stroke patients and age cutoffs for enrollment of patients in acute stroke trials may need additional considerations.

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